Apnoea

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Continuous positive airway pressure is effective at treating sleep apnoea in older people, a new study has found. Previous studies have established the benefits of CPAP in middle-aged people with OSA, but until now there has been no research on whether the treatment is useful and cost-effective for older patients.

The new research found that CPAP reduces how sleepy patients feel in the daytime and reduces healthcare costs. The researchers say CPAP should be offered routinely to older patients with OSA, and more should be done to raise awareness of the condition.

The study, published today in Lancet Respiratory Medicine, involved 278 patients aged 65 or over at 14 NHS centres in the UK. It was led by researchers at Imperial College London and the Royal Infirmary of Edinburgh in collaboration with the Medical Research Council Clinical Trials Unit at UCL, and the Universities of Oxford and York. It was funded by the National Institute for Health Research Health Technology Assessment (NIHR HTA) Programme.

Around 20 per cent of the adult population experiences breathing problems during sleep. In four to five per cent of middle-aged people, these problems lead to sleepiness in the daytime, classified as obstructive sleep apnoea syndrome. The condition is thought to be more common in older people, but the true prevalence is unknown, in part because patients and their relatives may attribute their sleepiness to old age, or older people can compensate by napping. The disease is becoming more common because obesity is a major risk factor.

Professor Mary Morrell, co-principal investigator of the study from the National Heart and Lung Institute at Imperial College London, said: “Sleep apnoea can be hugely damaging to patients’ quality of life and increase their risk of road accidents, heart disease and other conditions. Lots of older people might benefit from this treatment. Many patients feel rejuvenated after using CPAP because they’re able to sleep much better and it may even improve their brain function.”

Patients with sleep apnoea sometimes stop breathing for 30 seconds or longer at night before they wake up and start breathing again. In these pauses, their blood oxygen levels fall.

“We think low oxygen levels at night might accelerate cognitive decline in old people, and studies have found that sleep apnoea causes changes in the grey matter in the brain. We’re currently researching whether treatment can prevent or reverse those changes,” said Professor Morrell.

Co-principal investigator Dr.Renata Riha, Consultant and Honorary Reader at the Royal Infirmary of Edinburgh, added that sleep medicine spans many disciplines and comprises an important area of research which deserves support and greater recognition by funding bodies, universities and public policy makers. “Sleep disorders, such as sleep apnoea, impact on a wide variety of chronic conditions, potentially leading to their development or worsening them, including diabetes, heart attacks, strokes and possibly even cancer. Successful treatment diminishes this risk but we still have a great deal of work to do in the area,” she said.

Source: Imperial College London

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In what is the largest study to date on the association between the two conditions, researchers in Canada demonstrated a link between obstructive sleep apnoea (OSA) – a common breathing disorder that affects people during sleep – and the development of type 2 diabetes.

The team led by Dr Tetyana Kendzerska of the University of Toronto analysed data from 8,678 adults with suspected OSA and without diabetes at baseline who took part in a diagnostic sleep study between 1994 and 2010. All of the participants were tested for OSA and graded according to the severity of their sleep apnoea, based on the number of apnoeas (complete blockage of the upper airway) and hypopnoeas (partial blockage of airway) experienced per hour of sleep, and followed for development of diabetes.

During follow-up, 1,017 (11.7%) of the participants were diagnosed with type 2 diabetes. After adjusting for known risk factors for the disease, including age, sex, BMI, neck circumference and smoking at baseline, those classed as having severe OSA had a 30% greater risk of developing type 2 diabetes compared to those without OSA. Diabetes risk was also 23% higher for patients with mild or moderate OSA. In addition, Rapid eye movement sleep, lack of oxygen in the blood, and activation of the sympathetic nervous system, as indicated by a higher average heart rate during sleep, were linked to higher diabetes risk.

“After adjusting for other potential causes, we were able to demonstrate a significant association between OSA severity and the risk of developing diabetes,” Dr Kendzerska said in a statement. “Our findings that prolonged oxygen desaturation, shorter sleep time and higher heart rate were associated with diabetes are consistent with the pathophysiological mechanisms thought to underlie the relationship between OSA and diabetes.”

The lead author added that the results “address some of the limitations of earlier studies on the connection between OSA and diabetes”, as their study involved a larger sample size and a longer median follow-up. The researchers did, however, acknowledge a few limitations to the study, including not being able to screen for family history of diabetes and ethnicity.

“The OSA-related predictors of increased diabetes risk that we found in our study may allow for early preventative interventions in these patients,” Dr. Kendzerska concluded.

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Both men and women appear to have a greater risk of stroke if they suffer from obstructive sleep apnea, researchers found.

Through up to 14 years of follow-up, stroke risk increased along with the obstructive sleep apnea index to a similar extent in both men and women, according to Suzanne Bertisch, MD, instructor in medicine at Harvard Medical School/Beth Israel Deaconess Medical Center in Brookline, Mass.

The 5-year probability of having a stroke with the least severe obstructive sleep apnea index was 0.4% for women and 0.6% for men, while the probability in the highest quartile of obstructive sleep apnea severity was 1.2% for women and 1.8% for men, she reported at the American Thoracic Society meeting in San Diego.

At 10 years, the probability of having a stroke if you were in the lowest quartile of the sleep apnea index was 0.9% for women and 1% for men, while the probability of having a stroke in the highest quartile of the apnea index was 2.3% in women and 3.1% in men.

All results were adjusted for various confounders, including age, race, education level, smoking status, diabetes, hypertension, and body mass index, she said.

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Sufferers of a common sleep-breathing disorder have diminished activity among neurons responsible for keeping heart rate low, reveals a new study published today [16 May] in The Journal of Physiology.

The research discovered that in obstructive sleep apnoea (OSA), neurons in the brainstem that control heart rate experience a blunting of their activity. The reduction of neuronal activity likely contributes to the increased heart rate, blood pressure and risk of adverse cardiovascular events that occur in patients with OSA.

OSA is a common cardiovascular disease, occurring in 24% of adult males and 9% of adult females, which causes repetitive interruptions of breathing during sleep. Lack of oxygen during these episodes brings the person to a lighter state of sleep or brief wakefulness to restore normal breathing. Cycles of interrupted breathing and arousal from sleep can occur as frequently as once per minute.

Dr David Mendelowitz, who led the study at The George Washington University USA, says:

“Lack of sleep leaves the mind and body tired, leading to poor mental and physical performance, and if untreated OSA increases a person’s risk of developing hypertension and irregular heartbeats. Therefore it is very important that we have discovered some of the underlying mechanisms that could injure the heart and other cardiovascular tissues.

“Our study shows that progression of blunted cardiovascular reflexes is accompanied, and likely maintained by, inhibition of neurons in the brainstem that protect the heart and normally maintain a low resting heart rate. This study would predict that patients who have OSA, and also take sleep medicines, might be at heightened risk for an exaggerated reduction of essential neuronal activity that protects the heart.”

The team explored these mechanisms in rats, by mimicking OSA for four weeks and studying the changes in blood pressure, heart rate, and synaptic activity in parasympathetic neurons that control heart rate.

Future work will need to build from this foundation and focus on finding targets to restore the usual cardio-protective function of these neurons to help reduce the risk of arrhythmias, elevated heart rate, and blood pressure that occur with this disease.

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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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A new study suggests that patients with spinal cord injuries could benefit from careful assessment for sleep apnoea.

Results show that 77 percent of spinal cord injury survivors had symptomatic sleep-disordered breathing, and 92 percent had poor sleep quality. The study also found that the nature of sleep-disordered breathing in patients with spinal cord injury is complex, with a high occurrence of both obstructive and central sleep apnea events. The occurrence of central sleep apnea, which requires special consideration in diagnosis and treatment, was more common in patients with a cervical injury than in those with a thoracic injury.

“The majority of spinal cord injury survivors have symptomatic sleep-disordered breathing and poor sleep that may be missed if not carefully assessed,” said principal investigator and lead author Dr. Abdulghani Sankari, physician scientist at John D. Dingell VA Medical Center and Wayne State University School of Medicine in Detroit, Mich. “Our findings help in identifying the mechanism of sleep-disordered breathing in spinal cord injury and may provide potential targets for new treatment.”

The study results appear in the Jan. 15 issue of the Journal of Clinical Sleep Medicine, which is published by the American Academy of Sleep Medicine.

“Sleep-disordered breathing may contribute to increased cardiovascular mortality in spinal cord injury patients,” said American Academy of Sleep Medicine President Dr. M. Safwan Badr, who was involved in the study. “All spinal cord injury patients should undergo a comprehensive sleep evaluation using full, overnight polysomnography for the accurate diagnosis of sleep apnea.”

Sankari and his team studied 26 chronic spinal cord injury patients, including 15 with cervical and 11 with thoracic injuries. All subjects had baseline spirometry, a battery of questionnaires and attended polysomnography with flow and pharyngeal pressure measurements.

According to the authors, this is the first study to assess sleep-disordered breathing and ventilation changes comparing two different levels of spinal cord injury — cervical vs. thoracic

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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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