Apnea

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Sleep apnea is common in people with multiple sclerosis and may contribute to their fatigue, a new study shows. Fatigue is one of the most frequent and debilitating symptoms experienced by MS patients. The study included 195 people with MS who completed a sleep questionnaire and were assessed for daytime sleepiness, insomnia, fatigue severity and sleep apnea.

One-fifth of the patients had been diagnosed with sleep apnea and more than half were found to have an elevated risk for the condition. The researchers also found that sleep apnea risk was a significant predictor of fatigue severity.

MS is a chronic, frequently disabling disease that attacks the central nervous system, according to the National Multiple Sclerosis Society. Symptoms range widely, from mild signs such as numbness in the limbs to severe symptoms including paralysis or loss of vision.

The new findings suggest that sleep apnea may be a common but under-recognized contributor to fatigue in MS patients, and doctors should not hesitate to check these patients for sleep problems, study author Dr. Tiffany Braley, an assistant professor of neurology at the University of Michigan Multiple Sclerosis and Sleep Disorders Centers, said in an AASM news release.

“Obstructive sleep apnea is a chronic illness that can have a destructive impact on your health and quality of life,” and MS patients at high risk for sleep apnea should undergo a comprehensive sleep evaluation, academy president Dr. M. Safwan Badr said in the news release.

The study appears in the Feb. 15 issue of the Journal of Clinical Sleep Medicine, an AASM publication. About 400,000 people in the United States have MS, according to the National Multiple Sclerosis Society. Up to 7 percent of men and 5 percent of women have sleep apnea, according to the AASM.

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This conference aims to raise the profile of the preventability of road traffic injuries and promote good practices in order to achieve safe roads, safe speeds, safe vehicles, and safe people.

The Lincolnshire experience

In 2002 they were 104 fatal car accidents in Lincolnshire with a population of 700,000, so the Road safety Partnership (consisting of The NHS, Police and local Council) was formed to try and address and reduce this carnage on the roads. It was successful in reducing this figure to 79 per annum by a concerted effort to raise driver awareness via media messages with a budget of £3 million per annum, but seemed to stall at this figure.

In Lincolnshire we had a perfect storm of (similar in many respects to UAE):

(1) No existent service,

(2) The most obese population in Europe,

(3) Hazardous or dangerous roads

(4) No rail or other transportation infrastructure of note. 

In 2006 an ObstructiveSleepApnoeaservice was commissioned (it affecs 4-6 % of the population) to treat all the drivers that may fall asleep at the wheel and by 2008 fatal RTAs caused 52 deaths per annum and by 2012 it was 39 per annum.

This approach can also be successful in UAE

Sleep apnoea potentially affects 20% of UAE population, It could be responsible for a high number of car accidents, so if it is properly treated there should be a big reduction in car fatalities.

The conference is an important forum to inspire and connect leaders, decision makers, Health professionals, public servants, academics and advocates, bringing International keynote speakers and participants to seek, develop, and exchange views on what works to prevent road traffic accidents and how best to bring it to fruition in policy and practice for government and the private sector

1st International Road Traffic Accident Conference
21-22 November 2013
Emirates Palace Hotel, Abu Dhabi, UAE
www.menaconf.com

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ResMed has announced at the ESC Congress 2013, that SERVE-HF has completed enrollment. SERVE-HF is an international, randomised study of 1,325 participants investigating if the treatment of central sleep-disordered breathing (central sleep apnea) improves survival and outcomes of patients with stable heart failure.

Approximately 14 million people in Europe are living with heart failure and central sleep-disordered breathing is known to be a highly prevalent co-morbidity in these patients. With an estimated 30-50 percent of heart failure patients potentially at risk from this condition, the results from SERVE-HF may have important consequences for the future management of these patients.

“Completing recruitment of SERVE-HF has been an important milestone in this landmark trial,” said co-principal investigator, Professor Martin Cowie of the Royal Brompton Hospital in London. “We owe much to the commitment and dedication of SERVE-HF investigators and to a strong collaboration between sleep specialists and cardiologists. We now look forward to results in 2016 and to a fuller understanding of just how important the treatment of central sleep-disordered breathing is in heart failure patients.”

SERVE-HF will, for the first time, provide conclusive evidence of the health impact of effectively treating heart failure patients who have central sleep-disordered breathing. The trial, which began in 2008, is sponsored by ResMed. Designed as an event-driven study, its completion is anticipated by mid-2015 and results are expected to be available in the first half of 2016.

 

 

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Medical Xpress reports that women diagnosed with gestational diabetes are nearly seven times more likely to have obstructive sleep apnoea than other pregnant women, according to a recent study accepted for publication in The Endocrine Society’s Journal of Clinical Endocrinology & Metabolism (JCEM). Gestational diabetes causes glucose levels in the bloodstream to rise above normal levels. This form of diabetes occurs during pregnancy, typically in the second trimester. Between four and eight of every 100 pregnant women in the United States develop gestational diabetes.

The new study found a link between gestational diabetes and sleep apnoea, which causes brief interruptions in breathing during sleep. If sleep apnea goes untreated, it can raise the risk for stroke, cardiovascular disease and heart attacks.

“It is common for pregnant women to experience sleep disruptions, but the risk of developing obstructive sleep apnea increases substantially in women who have gestational diabetes,” said Sirimon Reutrakul, MD, who conducted the research at Rush University Medical Center in Chicago. “Nearly 75 percent of the participants in our study who had gestational diabetes also suffered from obstructive sleep apnoea.”

In a series of observational case control studies, researchers monitored 45 women for sleep apnoea and other sleep disruptions. The research examined sleep health in 15 pregnant women who had gestational diabetes, 15 pregnant women who did not have the condition and 15 women who were not pregnant and did not have diabetes.

The study found a strong association between obstructive sleep apnoea and gestational diabetes in this group of mostly overweight or obese women. Pregnant women who did not have gestational diabetes were able to get an additional hour of sleep and had less fragmented sleep than women who had gestational diabetes. Past research has shown lost sleep, fragmented sleep and shorter periods spent in deep sleep – all symptoms of sleep apnoea – are likely to raise the risk a person will develop diabetes.

“Based on these findings, women who have gestational diabetes should be considered for evaluation for obstructive sleep apnoea, especially if other risk factors such as hypertension or obesity are present, and women already diagnosed with sleep apnoea should be monitored for signs of gestational diabetes during pregnancy,” Reutrakul said.

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Lack of sleep can lead you to eat larger portions of high-calorie foods and increase your long-term risk of weight gain, according to a small new study. Swedish researchers asked 16 normal-weight males to choose their ideal portions of high-calorie meals and snacks. They did this when they had a normal night of about eight hours sleep and again when they went a night without sleep.

The participants chose larger portion sizes after the night with no sleep. They did this both before and after a breakfast, which suggests that sleep deprivation increases food intake regardless of whether a person feels full, said study author Pleunie Hogenkamp, of Uppsala University.

“Bearing in mind that insufficient sleep is a growing problem in modern society, our results may explain why poor sleep habits can affect people’s risk to gain weight in the long run,” Hogenkamp said in a university news release.

The study was published online Feb. 18 in the journal Psychoneuroendocrinology. In a previous study, the same team of researchers found that young, normal-weight men who went a single night without sleep had increased activation of a brain region involved in the desire to eat.

Although the study found an association between lack of sleep and increased appetite for high-calorie foods, it did not prove a cause-and-effect relationship.

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Sleep Apnea Prevention Project (S.A.P.P.) Video Launches Worldwide With Warren Sapp to Help Save Millions of Lives

Bioengineer, Sleep Apnea Expert and Zyppah Inc. Founder Dr. Jonathan Greenburg and Super Bowl XXXVII Champion Warren Sapp have joined together to raise global awareness about the importance of getting tested and treated for snoring and obstructive sleep apnea. The global awareness health initiative, Sleep Apnea Prevention Project (S.A.P.P.), released the first video segment of a documentary of Sapp undergoing sleep apnea testing and treatment.

In January, Sapp was tested and diagnosed with obstructive sleep apnea. Through the video, viewers will gain exclusive access to the real-life experiences of the sports legend as he embarks upon a personal journey to understand the root cause of sleep apnea and the importance of getting tested. Viewers can watch Sapp as he undergoes testing and learns about the treatment options available to cure his sleep apnea.

The purpose of the S.A.P.P. is twofold:

1. GLOBAL AWARENESS: The project delivers an impactful message to the media, medical community and the millions who think of snoring as a nuisance. It illustrates how snoring, a warning sign of a more serious medical issue, is closely linked to Sleep Apnea. It also explains how untreated sleep apnea leads to serious health risks like stroke, heart disease, high blood pressure, Alzheimer’s and cancer.

2. PATIENT EDUCATION: The project provides a clear message explaining the root cause of snoring and sleep apnea. The documentary illustrates medical advances that make it more convenient to get tested and treated. It compares the patient experience and results of the home sleep test to those conducted in sleep labs. It explains the various treatments available (surgery, CPAP and oral appliances) and how these methods work to cure sleep apnea.

It is estimated that over 100 million people worldwide have sleep apnea and 80% are undiagnosed. Delivering the message that early detection and treatment of sleep apnea can extend and save lives is the goal of S.A.P.P. For more information and links to the video, follow Warren Sapp on Twitter @WarrenSapp

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The British Snoring and Sleep Apnoea Association is launching a UK-wide survey into public awareness of the condition, with the aim of testing public knowledge about signs, symptoms and health risks associated with sleep apnoea.

To make it the most comprehensive survey yet, the association is looking for adult participants from all walks of life, saying participation will be valuable whether people have the condition or think they may have it, know somebody who has it, or even know nothing at all about it.

Marianne Davey, Msc, director of the British Snoring and Sleep Apnoea Association, said around half the UK population snores, or is directly affected by a snorer:

“Sleep apnoea is an everyday condition that no-one has ever heard of. Quite a few of us suffer it and many of us come across it in friends and family members, yet so few of us know what it is or even what it’s called. So we’re now launching a UK-wide public survey into public awareness of sleep apnoea, what it is and how to deal with it, which will help us tackle the problem. We welcome a wide range of participants, from those who know they suffer from sleep apnoea to those who’ve never even come across it.”

The survey will run until the end of January and the results will be published during National Stop Snoring Week, which will run from April 22 to 27.

The survey can be found on the front page of the association’s web site at: www.britishsnoring.co.uk

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David Volpi, otolaryngology surgeon, writes in the Huffington Post that researchers are finding that US veterans are 5 times more likely to be diagnosed with sleep apnoea than the general population.

“According to the U.S. Department of Veterans Affairs (VA), one out of every five war veterans has been diagnosed with OSA — compared with only five out of 100 civilians in the general population. And between 2008 and 2010, the number of veterans who received medical benefits related to sleep apnea grew by 61 percent, from 39,145 cases in 2008 to 63,118 cases in 2010.

“These numbers beg the question: Why do war veterans suffer from sleep apnea more than non-war veterans and civilians? Some VA doctors believe that it is due to the high number of repeat deployments to Iraq and Afghanistan — soldiers are being exposed to higher levels of dust, smoke, stress and violence.”

But what is at the core of this connection between war, OSA and other related conditions, such as daytime sleepiness, memory loss, a decrease in work productivity, obesity, heart disease, diabetes, and hypertension? Researchers at the Wayne State University (WSU) School of Medicine are beginning to find out.

The research shows that:

“Those who left Iraq after the war began and suffered from mental disorders such as post-traumatic stress disorder (PTSD) and depression and self-rated their physical health as worse than their actual health were 43 times more likely than pre-Gulf War immigrants to report OSA and later develop major chronic health issues, such as cardiovascular disease.”

This research was published in Psychosomatic Medicine in October 2012.

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It is possible that pregnant women can develop sleep apnoea during pregnancy. In studies of non-pregnant populations, a 20 % weight gain has a very significant impact on the development of OSA. Since pregnant women often have similar weight gains it is theoretically possible that many will develop breathing problems that can affect the developing fetus.

Snoring is the lowest level of sleep disordered breathing. Only 4% of healthy young women snore; the fact that reports of snoring increase to 25% of pregnant women by the third trimester, points to other possible negative side-effects of compromised breathing. The more overweight a woman is before she gets pregnant, the more likely there will be alterations in her breathing at night. Studies of pregnant women show that snorers have higher blood pressure than non-snorers.

Sleep apnoea is known to increase blood pressure in patients, in the beginning this is seen only during sleep and could be missed at a medical appointment. There is a pregnancy-induced hypertension that can develop after the 20th week of pregnancy and can cause many problems with the developing baby and the mother’s health. When this gets out of control, it is called preeclampsia or, worse yet, eclampsia and can be fatal. Known risk factors for preeclampsia include family history, advancing maternal age, obesity, chronic hypertension and kidney disease.

As of now, no one knows if sleep apnoea, and the intermittent lack of oxygen it causes at night, causes the blood vessel breakdown in the placenta seen with preeclampsia or if the retention of fluid from the preeclampsia causes the breathing problems due to tissue swelling all over the mother’s body. Obstetricians are always on the lookout for this condition and will treat it aggressively.

Treatment of Sleep Apnoea during pregnancy:

Who should be treated?

Any woman who is diagnosed with severe sleep apnoea or who has drops in her blood oxygen level below 90% must be treated as quickly as possible. If the mother is not breathing properly at night, the fetus can suffer growth retardation which impacts the baby’s survival after delivery.

How should she be treated?

CPAP (Continuous Positive Air Pressure): There is no other option that will be as helpful for the fetus. It is not sexy, or comfortable, but it is only required during the remainder of the pregnancy and will help protect the baby. Oral appliances, though effective, require time to fabricate and up to three months to be maximally effective. By the time effective oral appliance therapy is instituted, the pregnancy will be over.

Surgery: is less effective than any other therapy for sleep apnea and not an approach to be taken during pregnancy.

What to do after delivery?

Women who develop sleep apnoea during pregnancy should have a follow-up sleep study after regaining her normal weight (2-3 months after delivery) This will verify if the sleep apnea has resolved. Some women take longer to shed the extra weight of pregnancy and may continue to have sleep apnea. Since sleep apnea makes people feel sleepy, and a new baby also disrupts a mother’s sleep, treatment is necessary to keep the new mother from experiencing severe sleep deprivation. Some researchers have wondered if this loss of sleep may be part of the cause of “post-partum depression”.

Source: Pien GW; Schwab RJ. Sleep disorders during pregnancy. SLEEP 2004;27(7):1405-17.

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