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People with sleep apnea, a common sleep disorder, may be at increased risk for the bone-thinning disease osteoporosis, especially women and older people, a new study suggests.

Sleep apnea causes repeated, brief interruptions in breathing during sleep. Untreated sleep apnea can increase a person’s risk of heart disease, heart attack and stroke.

“Ongoing sleep disruptions caused by obstructive sleep apnea can harm many of the body’s systems, including the skeletal system,” said study co-author Dr. Kai-Jen Tien, of Chi Mei Medical Center in Tainan, Taiwan.

“When sleep apnea periodically deprives the body of oxygen, it can weaken bones and raise the risk of osteoporosis,” Tien said. “The progressive condition can lead to bone fractures, increased medical costs, reduced quality of life and even death.”

For the study, published April 15 in the Journal of Clinical Endocrinology & Metabolism, researchers analyzed the medical records of nearly 1,400 people in Taiwan diagnosed with obstructive sleep apnea between 2000 and 2008. They compared them with more than 20,600 people who did not have the sleep disorder.

Over six years of follow-up, people with sleep apnea were 2.7 times more likely to be diagnosed with osteoporosis. The risk for the bone-thinning disease was highest among women and older people with sleep apnea, according to the study.

“As more and more people are diagnosed with obstructive sleep apnea worldwide, both patients and health care providers need to be aware of the heightened risk of developing other conditions,” Tien said in a journal news release. “We need to pay more attention to the relationship between sleep apnea and bone health so we can identify strategies to prevent osteoporosis.”

However, the study only noted an association between sleep apnea and osteoporosis. It does not prove that one causes the other.

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Rose Wood Hotel, Abu Dhabi on 10th-11th March, 2014.

Road traffic injuries remain a global public health problem. Road accidents cause human tragedies every minute of every day. Nearly 3,400 people die on the world’s roads every day. Tens of millions of people are severely injured or disabled every year. Children, pedestrians, cyclists and the elderly are among the most vulnerable of road users. While many countries addressing the issue of road fatalities and serious injuries caused by road accidents, road safety still remains a challenging problem across the region and throughout the world.

The 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.

This worthwhile event will brings together an effective mix of practitioners,leaders, and researchers in road traffic accidents with a focus on understanding the problem and evidence-based, practical, deliverable outcomes which can be adopted in many circumstances. The list of keynote speakers demonstrates the commitment to bringing together global leaders, internationally recognised researchers, and demonstrably successful practitioners.

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.

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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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Sleeping Disorders Centre founder, Consultant ENT surgeon Michael Oko, will address senior international healthcare executives, public servants, and academics at the 1st International Road Traffic Accident Conference at the Rose Wood Hotel, Abu Dhabi, on 11th March 2014.

Mr Oko, a UK government advisor on Obstructive Sleep Apnoea (OSA) strategy, will be speaking about the benefits of preventative treatment in reducing road traffic accidents, using the example of Lincolnshire UK, where traffic fatalities have fallen significantly since sleep apnoea testing and treatment began. Professor Ram Dhillon (Middlesex University and Sleeping Disorders Centre) will also address the conference on “Snoring & Preventable Deaths on the Road: A Common, medically treatable, and often missed cause of Road Traffic Accidents.”

Mr Oko said:

“It is suspected that about 20% of car accidents are sleep related and research has shown that sleepiness can impair driving more than drink! Indeed, patients with OSA have a 7-12 fold chance of a road traffic accident (RTA) compared to those who do not, and results in Lincolnshire have shown that treating the condition can reduce the accident rate dramatically. With the low level of awareness of sleep apnoea in the Middle East it’s no surprise that road accident rates in the Gulf region are high. In fact, road traffic accidents are the second major cause of death in the UAE and there are 3500 fatalities per year from RTAs in Saudi Arabia alone. I believe that the success I have had in Lincolnshire can be replicated in the Middle East by raising awareness of the condition, and forming long-term partnerships with local hospitals, doctors, and government departments.”

Mr Oko has already been very active in bringing this message to the healthcare community in the Middle East. For his work in this area Mr Oko was awarded the Middle East Hospital magazine award for excellence in respiratory care in 2011 and 2013.

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A link has already been found between sleep apnea and hypertension but recent research suggests that if people have sleep apnea and hypertension, they should treat sleep apnea first and it will take care of hypertension.

The study involved 194 patients who were diagnosed with hypertension and also suffering from sleep apnea. Some patients were randomly administered CPAP while others were not. The patients continued to take their blood pressure medications.

It was found that those patients who received CPAP showed reduction in their blood pressure. Their average blood pressure of 24 hours was lowered 3.1 mm/Hg more than those who didn’t receive CPAP. Diastolic blood pressure also gets reduced by 3.2 mm/Hg. The study lasted for 12 weeks. At the end of the study, researchers noted that 36% of CPAP receiving patients showed 90% decline in their night time blood pressure as compared to 22% of those who didn’t receive CPAP.

Researchers found that prevalence of sleep apnea in patients who are suffering from hypertension is very high and undergoing from a standard sleep apnea treatment is beneficial for the patient. The further advised that individuals having sleep apnea should undergo sleep study to determine whether they are suffering from constructive sleep apnea.
Further studies are needed to evaluate long term benefits of this treatment.

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It’s well-established that obstructive sleep apnea is linked with increased heart risks. But now, a new study teases apart what exactly it is about the sleep disorder, characterized by pauses in breathing during sleep leading to disrupted sleep, that seems to predict these cardiovascular events.

Obstructive sleep apnea is measured by the number of times a person stops breathing during sleep (the apnea-hypopnea index, or AHI). However, researchers found that there were a number of other elements of sleep apnea that seemed to be predictive of cardiovascular events. The biggest one: the amount of time spent sleeping when the oxygen saturation was below 90 percent.

Other elements associated with a cardiovascular event included heart rate, daytime sleepiness, number of awakenings during the night, sleep time and leg movements, the researchers found. While the apnea-hypopnea index was associated with cardiovascular events when it was looked at by itself, it was no longer considered a significant predictor once all the other elements were factored in.

The study, published in the journal PLOS Medicine, is based on 10,149 people with obstructive sleep apnea who underwent diagnostic polysomnography between 1994 and 2010; 1,172 of those people developed cardiovascular disease.

“We believe a revision of the operative definition of OSA [obstructive sleep apnea] may be necessary, to reflect not simply the frequency of apneas and hypopneas, but the actual physiologic consequences that result — the severity of oxygen desaturation, sleep fragmentation, sleep deprivation and sympathetic activation,” the University of Toronto and St. Michael’s Hospital researchers said in the study. “It is these ‘downstream’ phenomena that we have found to be more predictive of CV [cardiovascular] risk.”

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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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There’s more bad news for women with sleep apnea. A new study from the UCLA School of Nursing shows that the body’s autonomic responses — the controls that impact such functions as blood pressure, heart rate and sweating — are weaker in people with obstructive sleep apnea but are even more diminished in women.

Women with obstructive sleep apnea may appear to be healthy — having, for instance, normal resting blood pressure — and their symptoms also tend to be subtler, which often means their sleep problem is missed and they get diagnosed with other conditions.

“We now know that sleep apnea is a precursor to bigger health issues,” said Paul Macey, lead researcher on the study, which appears Oct. 23 in the peer-reviewed journal PLOS ONE. “And for women in particular, the results could be deadly.”

Obstructive sleep apnea is a serious disorder that occurs when a person’s breathing is repeatedly interrupted during sleep, sometimes hundreds of times. Each time, the oxygen level in the blood drops, eventually resulting in damage to many cells in the body. The condition affects more that 20 million adults in the U.S. and is associated with a number of serious health consequences and early death. Women are much less likely to be diagnosed than men.

For the study, men and women — both with and without obstructive sleep apnea — had their heart-rate responses measured during three physical tasks:

  • The Valsalva maneuver: Subjects breathe out hard while the mouth is closed.
  • A hand-grip challenge: Subjects squeeze hard with their hand.
  • A cold pressor challenge: A subject’s right foot is put in almost-freezing cold water for a minute.
In all three tests, changes to the normal heart rate were lower and delayed in patients with obstructive sleep apnea, compared with healthy controls. The researchers found that the difference was even more pronounced in women.

 

“The heart-rate results for these tests show that the impact of sleep apnea, while bad in men, is more severe in women,” Macey said. “This may mean that women are more likely to develop symptoms of heart disease, as well as other consequences of poor adaptation to daily physical tasks. Early detection and treatment may be needed to protect against damage to the brain and other organs.”
The next step in the research is to see if the autonomic responses improve with treatments such as continuous positive airway pressure (CPAP), the usual sleep apnea therapy, in which a machine is used to help an individual breathe easier during sleep. Researchers also intend to investigate the affect of other treatments.

The study was funded by the National Institutes of Health and the National Institute of Nursing Research. Other authors of the study included Rajesh Kumar, Mary Woo, Frisca Yan-Go and Ronald Harper, all of UCLA.

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Writing in Arab News, leading sleep apnoea expert, Professor Ram Dhillon of the Sleeping Disorders Centre, spells out the dangers of sleep apnoea. Professor Ram Dhillon and his colleague, Sleeping Disorders Centre founder Michael Oko, will be speaking at the 1st International Road Traffic Accident Conference being held in May 2014 in Abu Dhabi, UAE.

“Untreated or inadequately treated OSA is associated with major medical problems. If one considers the OSA event as a strangulation leading to poor oxygen levels to every cell in the body it is easy to understand the detrimental consequences. It may lead to high blood pressure, cause a pre-diabetic state and make existing diabetes more difficult to manage. There is an increased incidence of heart problems such as heart attacks and heart rhythm disorders. There is also an increased likelihood of suffering a stroke and the kidneys can also be damaged. Studies reveal untreated severe OSA will lead to death in 15% of patients and a major heart event in 30 percent over a 12-year period.

“There is an increasing awareness of the relationship between OSA and falling asleep during the boredom of driving, particularly on long straight roads. This is an issue for all road users but is likely to be a much greater problem in the haulage industry.”

• Professor Ram Dhillon is the consultant surgeon at Middlesex University, School of Health and Social Sciences, London. Michael Oko, consultant surgeons and Department of Health Adviser on Sleep Apnea, UK National Health Service, also contributed to this report.

Source: Arab News

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