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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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Health 24 reports that sleep apnoea raises the risk of sudden cardiac death, according to a long-term study that strengthens a link doctors have suspected. The new research is published online June 11 in the Journal of the American College of Cardiology.

“The presence and severity of sleep apnoea are associated with a significantly increased risk of sudden cardiac death,” said study leader Dr. Apoor Gami, a cardiac electrophysiologist at Midwest Heart Specialists-Advocate Medical Group in Elmhurst, Ill.

Sudden cardiac death kills 450,000 people a year in the United States, according to study background information. It occurs when the heart unexpectedly and suddenly stops beating due to problems with the heart’s electrical system. Those problems cause irregular heartbeats. The condition must be treated within minutes if the person is to survive.

In earlier research, Gami and his team had found that patients with sleep apnoea who suffered sudden cardiac death often did so at night, a completely opposite pattern than found in others without sleep apnea who had sudden cardiac death. In the new study, the researchers tracked more than 10,000 men and women, average age 53, who were referred for sleep studies at the Mayo Clinic Sleep Disorders Center, mostly due to suspected sleep apnoea, from 1987 through 2003. After sleep tests, 78 percent were found to have sleep apnoea. During the follow-up of up to 15 years, they found that 142 had sudden cardiac arrest, either fatal or resuscitated.

Three measures strongly predicted the risk of sudden cardiac death, Gami said. These include being 60 or older, having 20 apnoea episodes an hour or having low blood levels of oxygen. This “oxygen saturation” drops when air doesn’t flow into the lungs. “If the lowest oxygen saturation was 78 percent, or less, their risk of [sudden cardiac death] increased by 80 percent,” Gami said. In a healthy person, 95 percent to 100 percent is normal. Having 20 events an hour would be termed moderate sleep apnea, Gami said.

Gami found a link, not a cause-and-effect relationship, between sleep apnea and sudden cardiac death. He can’t explain the connection with certainty, but said there are several possible explanations. For example, sleep apnea is related to the type of heart rhythm problem that causes sudden cardiac death, he said. The study findings should be taken seriously by those who have sleep apnea or suspect they do, said Dr. Neil Sanghvi, an electrophysiologist at Lenox Hill Hospital, in New York City, who reviewed the findings.

People with sleep apnea are often but not always obese, and many have other heart risk factors such as heart failure or heart disease. Having these other risk factors already puts a person at risk of sudden cardiac death, Sanghvi said. “The sleep apnea may be the tipping point. Each of these factors adds a level of risk. When you add sleep apnea, you could have a worse outcome.”

Anyone who suspects they have sleep apnea should ask their doctor about a sleep test, Sanghvi said. Daytime sleepiness and fatigue are frequent symptoms. Another tipoff is a bed partner who complains of snoring. The study didn’t address whether those who used sleep apnea treatments — such as the CPAP machine (continuous positive airway pressure) prescribed during sleep to help breathing — would reduce risk. “It would be fair to say we suspect it would,” Gami said.

 

 

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Life longevity specialist Dr Dick Richards blogs on Breathing Relief about the dangers of lack of sleep to health, and side effects of sleep apnoea:

“The bad news is that this [sleep deprivation] causes a rapid fall in the ability of the metabolism to conduct its requisite routines of anti-oxidation and other tissue repairing processes. If repeated several times , as is usually the case, there can be significant falls in oxygenation levels in the blood leading to a recognisable state of what is called oxygen desaturation. The serious consequences over this were such that over thirty years ago there was a careful medical study [*] into the relationship between sleep loss and these unwelcome side effects. It was clearly shown that symptoms of the obstructive sleep apneoa [OSA] syndrome include excessive daytime sleepiness, nocturnal awakenings, reduced sexual inclination and performance, and morning headaches. A number of other mortality studies have suggested decreased survival statistics in persons with the OSA syndrome, possibly due to this causing vascular-related disease.”

We know sleep apnoea leads to greater incidence of hypertension and atherosclerosis related diseases such as stroke, angina, and acute myocardial infarct. In addition to shortened longevity in patients with untreated or inadequately treated OSA there are also other factors which could account for this early mortality, for example sudden death during sleep (arrhythmia) or even fatalities from sleep related automobile or other accidents.

 

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Snore Centre eNewsletter March 2012

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A new British study suggests that moderate-to-severe sleep apnoea can reshape the heart, increasing its size, thickening its walls and reducing its ability to pump blood throughout the body.

However, the study also found that at least six months of continuous positive airway pressure (CPAP) treatment can help restore the heart’s size and function to nearly normal levels. CPAP uses a mask to deliver pressurised air into the airway of sleepers.

“To the best of our knowledge, this is the first study to provide a comprehensive assessment of left ventricular [heart] structural and functional parameters using advanced echocardiograms in otherwise healthy apnea patients,” said Dr. Gregory Lip, a researcher at the University of Birmingham Center for Cardiovascular Sciences, in England, in a journal news release.

According to Lip, the study shows that sleep apnoea “could be crucial” to the development of a certain type of heart dysfunction “that can lead to heart failure and increased mortality if left untreated.”

The researchers used two- and three-dimensional echocardiograms and Doppler imaging of heart muscle tissue to examine 40 people with moderate-to-severe obstructive sleep apnea, 40 people with high blood pressure and 40 people with no health concerns.

The study, published in Circulation: Heart Failure, revealed the patients with obstructive sleep apnea had abnormally shaped hearts. The hearts of those with sleep apnoea also functioned at the same level as those of patients with chronic high blood pressure.

Patients with sleep apnoea “may have cardiac abnormalities that often are undetected, but will improve with CPAP,” Lip reasoned. “Patients also need to understand that obstructive sleep apnea is not a benign disorder, but that their risk of heart problems can be easily treated with CPAP.”

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Severe obstructive sleep apnea was associated with a risk of cardiovascular death in women, but continuous positive airway pressure (CPAP) seemed to reduce the risk, according to a small Spanish study.

In a 116-patient, observational study, those with severe obstructive sleep apnea had a cardiovascular mortality rate of 3.71 per 100 person-years compared with the control group’s rate of 0.28 per 100 person years, Francisco Campos-Rodriguez, MD, from Valme University Hospital in Seville, Spain, and colleagues found.

Women with mild to moderate apnea had a mortality rate of 0.94 per 100 person-years (P=0.034 compared with the control group), they reported in the Annals of Internal Medicine.

Despite prevalence data suggesting that 2% to 3% of middle-age women have obstructive sleep apnea, most of the studies on both apnea and cardiovascular effects have been done exclusively in men. The researchers were interested in investigating this issue in a large group of women.

Source: Medpage Today

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The fourth annual World Sleep Day held on 18 March  – ‘Sleep Well, Grow Healthy’ – was themed to highlight the importance of sleep for people of all ages. Newborn infants, children, adolescents and adults, both young and old, need quality sleep to maintain a healthy life.

The scale of the problem was highlighted by the recently published Philips Index for Health and Wellbeing report – a massive consumer research study conducted across 23 countries, including the United Arab Emirates and Kingdom of Saudi Arabia, involving more than 31,000 people, revealed that 35 percent of people do not feel they get enough sleep, impacting on both their physical and mental health.

Interestingly, with almost half of those responding citing ‘poor sleeper in general’ as a reason for sleep deprivation – it suggests that many may have just resigned themselves to not ever getting a good night’s sleep.

In reality, there are a number of potential causes for a disturbed night’s sleep. These include sleep disorders such as Obstructive Sleep Apnoea (OSA), which affects approximately 4 percent of the adult population. It’s a disorder characterized by airway collapse (behind the tongue) during sleep, which obstructs breathing. If untreated, it can contribute to the development of high blood pressure, diabetes, heart attacks, and strokes. Snoring should also not be ignored in children, as it may be a symptom of OSA.

To find out more about World Sleep Day 2011, visit www.worldsleepday.org.

(source: extract from a Philips press release)

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