The research didn’t definitively link the rise in obesity to sleep apnoea, and it only looked at 1 520 people, almost all white, in Wisconsin. But study author Paul Peppard believes the findings show a big spike in sleep apnoea cases over the past two decades – as much as 55% – and may translate to the entire United States.

“There are probably 4 million to 5 million people who are more likely to have sleep apnoea due to the obesity epidemic,” estimated Peppard, an assistant professor of population health sciences at the University of Wisconsin-Madison. “It’s certainly an uncalculated cost of the obesity epidemic, an epidemic of its own.”

The researchers looked at adults aged 30 to 70 who were monitored as they slept. About 600 to 700 underwent sleep tests between 1988 and 1994, with some continuing to take part along with hundreds of new participants from 2007 to 2010. The study considered the participants to have moderate-to-severe breathing problems if they had trouble breathing 15 or more times an hour while sleeping.

Sleep apnea is the main cause of breathing problems during sleep. People with the condition often have trouble staying in deep sleep because their throats close, blocking their airways and requiring them to partially awaken to start breathing properly. They don’t realise they’re waking up and may become very sleepy during the day. Besides sleepiness, sleep apnea can contribute to heart and other health problems if untreated and increase the risk of work- and driving-related accidents, according to the US National Heart, Lung, and Blood Institute.

The researchers extrapolated their findings to the entire United States and estimated that 10% of men aged 30 to 49 currently have symptoms of sleep apnoea. The study estimates the number is 17% of men aged 50 to 70. For women, the estimate is 3% among those aged 30 to 49 and 9% among women aged 50 to 70. Among all groups, heavier people were much more likely than thinner people to suffer from the symptoms.

The study estimates that these numbers have gone up by 14% to 55% from 1988-1994 to 2007-2010. Peppard estimated that 80% to 90% of the increase in symptoms is due to the growth in obesity. But it’s hard to know for sure how much of a role that obesity plays in causing more symptoms. While obesity is “almost certainly the biggest factor” in causing sleep apnoea, Peppard said, “there’s long list of things that cause sleep apnea or are related to sleep apnea, like being older, being male, having a narrower upper airway, having a genetic predisposition to it…”

Although the study tied obesity to higher risk of having sleep apnoea, it did not establish a cause-and-effect relationship.

SDCnewsletterApril2013

Consultant ENT surgeon Michael Oko, UK government advisor on Obstructive Sleep Apnoea (OSA) and founder of the Sleeping Disorders Centre, ran a seminar on sleeping disorders at the 10^th Middle East Update in Otolaryngology last week.

Mr Oko presented data on the morbidity of OSA, and revealed his experience of how treating it can reduce fatal car accidents, as evidenced in Lincolnshire, UK:

“Because of a prolonged campaign about the condition and the better treatment options available after the Sleeping Disorders Centres were established, we have seen the rate of annual traffic fatalities in Lincolnshire fall from 79 to 39 within five years. At least any traffic accidents brought about by this condition can be minimised if more patients seek help. Studies show that up to 20% of road traffic accidents are sleep-related, so with over 1000 road deaths a year in UAE, and over 6300 in Saudi Arabia [2007 police data], a sleep apnoea testing and treatment programme could reduce fatalities significantly.”

In the seminar Mr Oko also spoke about the history of OSA, and how it could be the future of ENT. He stated:

“Obstructive Sleep Apnoea has been known about since 1956 and has been predominantly the domain of respiratory physicians. There is now overwhelming evidence that this is a highly cost effective condition to treat, and as the definition of the condition is upper airway obstruction it is de novo the domain of ENT to lead the management of this condition in a multidisciplinary team approach. There have been consistent and multiple attacks on the evidence base for most ENT interventions (e.g. Tonsillectomy) and so to survive as a specialism we need to embrace OSA as our future.”

OSA is a rising problem in the Gulf as obesity levels (the major risk factor for OSA) are reaching those of the US and Europe. Hard data is scarce due to a lack of awareness of the condition and scarcity of treatment facilities in the region, however, a study conducted at King Khalid University and King Fahd National Guard primary health care clinics in Riyadh, between December 2005 and March 2006, found that a third of middle-aged Saudi males taking part showed symptoms of sleep apnoea.

Speaking alongside Mr Oko was Professor Ram Dhillon, giving; “Tips and pearls on practical aspects of sleep apnoea treatment”,  and Peter J Catalano, who asked; “Nasal surgery for OSA: Always, sometimes, never?”. Also on the panel were Gerald Wolf and Ahmed Elbassiouny.

AME info report on the seminar

In one study, they tested the driving ability of 133 patients with untreated sleep apnea and 89 people without the condition using a simulated driving test. As they navigated the roughly 56-mile course, the “drivers” were assessed on completion, time spent in the middle lane, unprovoked crashes and crashes caused by veering off the road.

Twice as many people with untreated sleep apnoea (24%) failed the driving test, compared to 12% of those who didn’t have the condition. The researchers noted many of the sleep apnea patients couldn’t complete the test. They also had more crashes and had difficulty following a clear set of directions given at the start of the test.

“Driving simulators can be a good way of checking the effects that a condition like sleep apnoea can have on driving ability,” said the study’s chief investigator, Dr Mark Elliott, in a news release from the European Lung Foundation. “Our research suggests that people with the condition are more likely to fail the test.”

In another study, 118 people with untreated sleep apnea completed a survey about their driving behaviour and also took the simulated driving test. Their results were compared to those of 69 people who didn’t have sleep apnoea. More than one-third (35%) of those with sleep apnoea admitted to nodding off while driving. The researchers noted 38% of this group also failed the driving test. In contrast, only 11% of those without sleep apnoea admitted falling asleep while driving. And none of the motorists without sleep apnoea failed the driving test.

The study will be presented today (11 April 2013) at the Sleep and Breathing Conference in Berlin, organised by the European Respiratory Society and the European Sleep Research Society.

Previous research has demonstrated that people with sleep apnoea are less productive at work, usually due to excessive daytime sleepiness. This study aimed to assess whether continuous positive airway pressure (CPAP) improved productivity at work.

The researchers used the Endicott Work Productivity Scale, a questionnaire designed to assess productivity at work, and the Epworth Sleepiness Scale, a globally accepted questionnaire which assesses daytime sleepiness. Included were 45 patients with sleep apnoea of working age (between 40 and 56 years), who completed the questionnaires at the outset and after 3 months of CPAP treatment.

The results showed that 35 of the patients who had good adherence to CPAP treatment showed significant improvement in their productivity at work and in their daytime sleepiness. The 10 patients who did not follow the treatment programme had no significant improvement in symptoms or work productivity.

Lead author, Evangelia Nena MD, PhD, said: “Continuous positive airway pressure (CPAP) is the gold standard treatment for moderate-to-severe obstructive sleep apnoea. Previous research has shown the potential benefits of CPAP to patients’ health and quality of life and our findings add to this body of evidence, demonstrating the advantages the treatment can have on productivity at work.”

Dan Smyth, Sleep Apnoea Europe, said: “This study underlines the positive benefits of compliant use of Continuous Positive Airway Pressure (CPAP) Treatment Therapy for Sleep Apnoea sufferers. It also confirms that the symptoms of the condition can be controlled and that the patient can remain an effective member of the workforce.”

Michael Oko, consultant ENT surgeon, and Sleeping Disorders Centre founder, said:

“Sleep apnoea prevents people from getting a good night’s sleep by preventing air getting to the lungs. This leads to tiredness and irritability, and marital problems, and can also contribute to serious illnesses such as diabetes, hypertension and heart disease. Once people are aware they are suffering from the condition there are various treatments that can help them to overcome it, the most common being wearing a Continuous Positive Airway Pressure (CPAP) mask at night.”

Mr Oko, who recently appeared as an expert on a BBC1 programme about sleeping disorders “Goodnight Britain”, actively campaigns to raise awareness of sleep apnoea and writes a regular blog on the subject. He will be addressing the 10th Middle East Update in Otolaryngology in Dubai on 21st April 2013. He added:

“Almost all the survey respondents felt tired during the day, and must have suspected a sleeping disorder to have visited the site and completed the survey. I hope that more and more people will take this test and get help if they need it, as the survey shows; if you think you may have a sleeping disorder, the chances are that you do.”

Visitors to the Sleeping Disorders Centre website were asked to complete the STOP-BANG questionnaire, a set of eight questions regarded as the most accurate means of indicating a person’s level of risk of suffering from sleep apnoea from a self-conducted survey. Answering yes to three or more of the eight questions (measuring BMI, age, sex, neck size, snoring, fatigue, blood pressure, and observed apnoeas) indicates a high risk and that the person should visit their GP or go to a sleep clinic for an assessment.

“This study provides some helpful information for medical professionals consulting with parents about treatment options for children with [sleep-disordered breathing] that, although it may remit, there are considerable behavioral risks associated with continued SDB,” Michelle Perfect, PhD, the study’s lead author and an assistant professor in the school psychology program in the Department of Disability and Psychoeducational Studies at the University of Arizona in Tucson, said in a news release. “School personnel should also consider the possibility that SDB contributes to difficulties with hyperactivity, learning, and behavioral and emotional dysregulation in the classroom.”

The five-year study, which appears in the April issue of the journal Sleep, utilized data from a longitudinal cohort, the Tucson Children’s Assessment of Sleep Apnea Study. That study prospectively examined Hispanic and Caucasian children between ages 6 and 11 to determine the prevalence and incidence of SDB and its effects on neurobehavioral functioning. The study involved 263 children who completed an overnight sleep study and a neurobehavioral battery of assessments that included parent- and youth-reported rating scales.

Results show that 23 children had incident sleep apnea that developed during the study period, and 21 children had persistent sleep apnea throughout the study. Another 41 children who initially had sleep apnea no longer had breathing problems during sleep at the five-year follow-up.

The odds of having behavioral problems were four to five times higher in children with incident sleep apnea and six times higher in children who had persistent sleep apnea. Compared with youth who never had SDB, children with sleep apnea were more likely to have parent-reported problems in the areas of hyperactivity, attention, disruptive behaviors, communication, social competency and self-care. Children with persistent sleep apnea also were seven times more likely to have parent-reported learning problems and three times more likely to have school grades of C or lower.

According to the American Academy of Sleep Medicine, obstructive sleep apnea occurs in about 2% of children who are otherwise healthy. Children with sleep apnea generally have larger tonsils and adenoids than other children their age, and most children with sleep apnea have a history of loud snoring. Effective treatment options for children include the surgical removal of the tonsils and adenoids or the use of continuous positive airway pressure therapy.