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Didgeridoo inspires sleep apnea workout

Playing the Australian aboriginal wind instrument seems to help those affected

From Friday's Globe and Mail

For many people afflicted with sleep apnea, the treatment may seem worse than the condition.

They must sleep with the aid of a device known as CPAP (continuous positive airway pressure) that blows air down their throat to keep the passageway open. A lot of patients find it extremely difficult to sleep with a CPAP mask strapped to their face.

Now, however, Brazilian researchers have completed a study that suggests certain throat and tongue experiences may lessen sleep apnea - and thereby eliminate the need for the dreaded CPAP machine - in some patients.

Sleep apnea occurs when the soft tissues in the throat basically collapse shut. Those with the condition must wake briefly many times a night to gulp for air. They will have no recollection of waking, but suffer the consequences of poor sleep - fatigue the following day. Even worse, sleep apnea puts a strain on the heart and elevates the risk of getting high blood pressure, heart attack and stoke.

Most medical experts have long assumed that exercises would have little effect on the sleep disorder - and CPAP was the best treatment available.

But the Brazilian researchers were intrigued by a recent experiment that showed playing the didgeridoo, an Australian aboriginal wind instrument, seemed to help.

So the researchers, led by Geraldo Lorenzi-Filho of the University of Sao Paulo's medical school, recruited 31 patients recently diagnosed with mild to moderate sleep apnea in order to evaluate a series of exercises normally used for treating speech disorders.

About half of them were given tongue and throat exercises, while the others served as a control group. After three months, 10 of the 16 patients in the treatment group were reclassified as having just mild apnea or no apnea. What's more, neck circumference decreased by an average of 1.1 centimetres in this group, indicating that airway muscles had been significantly altered. There was no improvement in the control group.

"We think the exercises changed the tone of the upper airway muscles," making them less prone to collapse while asleep, said Dr. Lorenzi-Filho, whose findings were published in the American Journal of Respiratory and Critical Care Medicine.

Other experts are surprised by the results and not yet convinced the exercises will work. "I think future studies will need to tease out the specific benefits of the different exercises," said Catriona Steele, a research scientist at the Toronto Rehabilitation Institute.

Dr. Lorenzi-Filho agreed more study is needed before an exercise program is available for treating sleep apnea. Those who took part in the study did many different exercises "and we don't exactly know which ones work," he said.

And he emphasized that exercises can only go so far in reversing sleep apnea. That means such a treatment would likely be an option only for mild to moderate sleep apnea cases. Those with a severe condition will probably have to keep using CPAP.

Easier breathing for tots

Bronchiolitis is an extremely common lung infection that plagues many infants, leaving them wheezing and struggling for breath. In Canada, an estimated 35 out of every 1,000 babies are hospitalized with the condition each year. Yet doctors were never quite sure how best to treat the condition - until now.

A team of researchers from across Canada have published a new study showing that a combination of two drugs - epinephrine and dexamethasone - cuts hospital admission by 35 per cent.

"This is the first large study to show anything that really makes a difference in the risk of admission for these kids," said lead investigator Amy Plint of the Children's Hospital of Eastern Ontario.

She noted that doctors tended to prescribe either one of the drugs studied, but seldom both. Epinephrine relaxes the airways, while dexamethasone reduces inflammation. The combination appears to have a "synergistic effect" that produces a better result than either drug by itself, Dr. Plint said.

The study, published in The New England Journal of Medicine, could potentially reduce suffering of the tiny tots while saving the health-care system money.

The annual cost of hospitalization was estimated at $23-million in 1993 - and admission rates have doubled since that time.

Faux journal touts drugs

Pharmaceutical giant Merck paid an undisclosed sum to publishing firm Elsevier to produce several editions of what looked like peered-reviewed medical journals, but contained mostly glowing reports of the drug company's own products, according to The Scientist magazine.

The pseudo-publications, part of a Merck marketing effort to raise the profile of the company's drugs among Australian physicians, came to light during court proceedings.

One of the publications was titled The Australasian Journal of Bone and Joint Medicine and included positive articles on Merck's osteoporosis drug Fosamax and painkiller Vioxx.

In a statement released last week, Michael Hansen, chief executive officer of Elsevier's health sciences division, acknowledged that between 2000 and 2005, the company's Australia office published a series of sponsored articles that were made to look like journals and lacked proper disclosure. "This was an unacceptable practice and we regret that it took place," he said. "The individuals involved in the project have long since left the company."

Elsevier is a leading publisher of medical and scientific journals, including the Lancet. It also does contract work

for pharmaceutical firms, printing compilations of favourable medical studies and articles about company products. But it is normally expected that the company paying for such promotional literature is clearly disclosed in the material.

In a brief statement, Merck said it "agrees with Elsevier about the importance of appropriate disclosure of financial support." But the drug company declined to answer specific questions about the incident.

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