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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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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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The American Academy of Sleep Medicine (AASM) is advising anyone with Type 2 diabetes or hypertension to be evaluated for sleep apnea by a board-certified sleep medicine physician. The recommendation comes as the group of international clinicians and researchers meets in Baltimore for SLEEP 2013, the foremost gathering of sleep experts annually.

Overwhelming clinical evidence has shown that patients suffering from two very common illnesses – Type 2 diabetes and hypertension – are at much higher risk for obstructive sleep apnea (OSA), a dangerous condition characterized by episodes of complete or partial airway obstruction during sleep. Research also has shown that treating sleep apnea can help in the management of these two disorders.

“Type 2 diabetics and people with hypertension are much more likely to have obstructive sleep apnea than other people, and as a result should immediately discuss their risk for sleep apnea with a sleep specialist,” said M. Safwan Badr, MD, president of AASM. “Diagnosis and treatment of sleep apnea from a board-certified sleep medicine physician will promote improvement in these conditions – including improved insulin sensitivity, blood pressure and cholesterol.”

Type 2 Diabetes and Obstructive Sleep Apnea
According to the Centers for Disease Control and Prevention, 25.6 million Americans aged 20 years or older suffer from diabetes, and Type 2 diabetes accounts for about 90 to 95 percent of all diagnosed cases. Seven in 10 people with Type 2 diabetes also have obstructive sleep apnea, and the severity of the sleep disorder directly impacts diabetes symptoms; the more severe a diabetic’s untreated sleep apnea, the poorer their glucose control.

“Treating sleep apnea in diabetics improves nighttime glucose levels and insulin sensitivity,” said Badr. “Treatment also will provide benefits of improved sleep unrelated to diabetes – including increased alertness during the day and improved memory and cognitive function.”

A recent study from the University of Chicago shows that continuous positive airway pressure (CPAP) treatment of sleep apnea may have as much of an effect as prescribed oral diabetes medications.

“In our study, one week of optimal CPAP use lowered average 24-hour glucose levels and improved post-breakfast glucose response in Type 2 diabetics with obstructive sleep apnea,” said Esra Tasali, MD, lead author of the study and assistant professor of medicine, pulmonary and critical care medicine at the University of Chicago Department of Medicine. “The dawn phenomenon, an early-morning increase in blood sugar in people who have Type 2 diabetes, also was reduced by 45 percent as a result of CPAP therapy.”

Hypertension and Obstructive Sleep Apnea
High blood pressure, known as hypertension, is the most important risk factor for cardiovascular disease and is not limited to diabetes sufferers. A staggering 67 million Americans have high blood pressure, which is about one in every three adults. Between 30 and 40 percent of adults with high blood pressure also have sleep apnea, which is even more prevalent in those with resistant hypertension. Approximately 80 percent of patients that do not respond to hypertensive medications have sleep apnea. Seeking and adhering to sleep apnea treatment is a proven means of decreasing blood pressure.

“Evidence shows that sleep apnea treatment lowers nighttime and daytime blood pressure, with the greatest improvement in patients seeking treatment for moderate to severe sleep apnea,” said Badr. “The higher your blood pressure, the greater your risk of suffering a heart attack or stroke. Reducing your blood pressure lowers your risk of cardiovascular disease and improves your overall health.”

Source: AASM

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A new surgical treatment used to treat sleep apnoea has cured 70 per cent of patients involved in a Flinders Medical Centre study. It is the first time the technique, developed in China, has been properly evaluated.

FMC head of ear, nose and throat surgery, Professor Simon Carney, said the procedure was twice as effective as previous types of surgery.

“Our study of 48 sleep apnoea patients has shown that the technique has significant benefits, with the symptoms of every patient in the study improving,” Prof Carney said.

“The number of pauses in between the breathing of people involved in the study was reduced by 76 per cent and daytime sleepiness reduced by half.”

The hospital was the first in Australia to use the technique after the late Dr Sam Robinson brought it to Australia. The study also involved patients from the Illawarra ENT Head and Neck Clinic in New South Wales. The new technique, which requires only one night in hospital, involves repositioning tissue in the throat with a treatment that creates channels in the tongue.

The older technique was more painful and included the removal of a wedge in the tongue, before sewing it back together. “Often the patient wouldn’t be able to be guaranteed to talk or swallow completely normally afterwards and not surprisingly a lot of patients declined to have the surgery,” Prof Carney said.

“The results weren’t very good for a lot of these patients … only about 30 per cent of these patients got better.”

Prof Carney said the new technique took about 45 minutes and was much more successful.

“The technique is incredibly safe, easily taught and has long term benefits for the management of sleep apnoea within the health system.”

He said about five patients were now undergoing the procedure each month at Flinders and it was becoming available at other SA hospitals. But, he warned the technique was not a replacement for continuous positive airway pressure – a mask worn while sleeping – but an alternative for those where CPAP does not work, or was too intrusive.

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White-collared, globe-trotting executives over the age of 45 need to watch out for sleep apnoea, according to a recent study by the Madras ENT Research Foundation.

“Our estimates show that 24 per cent of men and 9 per cent of women above 45 years in the country suffer from this problem,” says Mohan Kameswaran, Managing Director of the foundation.

Those with obesity, diabetes and a sedentary lifestyle are more prone to sleep apnoea. Smoking, excessive consumption of alcohol and heavy snoring are other risk factors associated with this disorder. It is common among middle-aged working professionals.

“With intense travelling, they have very little time for physical activity and exercise. They do not maintain a good diet. When you are young, your muscle tone is good. But it slows down after 45,” cautions Kameswaran.

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Sleep-disordered breathing — which includes snoring and sleep apnea — isn’t just an adult condition: A new study from Finland shows that as many as one in 10 six-to-eight-year-olds may also have it.

The study, which was conducted by researchers from the University of Eastern Finland, included 512 kids from Finland between ages six and eight. The researchers examined their sleep disturbance status, as well as how their top and bottom rows of teeth fit together and their face shape (craniofacial morphology). Researchers found that being overweight and obese wasn’t linked with sleep-disordered breathing in kids, as it may be with older adults. Rather, craniofacial or dental issues seemed to be at play, according to the European Journal of Pediatrics study.

“If a child has symptoms of sleep-disordered breathing, his or her craniofacial status and dental occlusion need to be examined,” study researcher Tiina Ikävalko, an orthodontic specialist and a clinical lecturer at the university, said in a statement. “On the other hand, children with tonsillar hypertrophy, crossbite and convex facial profile should be examined to assess the quality of their sleep.”

The prevalence of sleep-disordered breathing in kids found in this study is not too different from that previously reported by the American Academy of Otolaryngology-Head and Neck Surgery, which said that snoring is commonplace in about 10 percent of all kids, and obstructive sleep apnea is prevalent in about 2 to 4 percent of kids.

Potential health risks from sleep-disordered breathing in kids include attention problems, bedwetting, increase in insulin resistance, increase in blood pressure, and even a decrease in growth hormone, the American Academy of Otolaryngology-Head and Neck Surgery reported. Since enlarged adenoids and tonsils are a common cause for sleep-disordered breathing in kids, getting these removed could help to treat the condition for some.

See article on Huff Post website and 10 health risks associated with sleep apnoea

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Just want to let you all know that I will be featuring in an upcoming BBC1 program called “Goodnight Britain” on November 29th at 9pm. Should be of interest to sleep apnoea sufferers, and hopefully get the issue some publicity

The program is in two parts. Part 1 is on Wednesday November 28th at 9pm, and part 2 is on Thursday November 29th at 9pm.

“Goodnight Britain tackles the nation’s biggest sleep disorders, meeting and curing some of the UK’s worst sleepers and exposing the extraordinary behaviour that lurks behind Britain’s bedroom curtains.”

“In the first part of a new two-part series presented by Sian Williams, Goodnight Britain’s sleep experts – Dr Kirstie Anderson and Dr Jason Ellis – venture into the bedrooms of five contributors tormented by a range of conditions, from parasomniacs who scream the house down and snorers whose trumpeting rattles the window-panes, to insomniacs who bake six hours a night.

Through the use of high-tech night-vision cameras, the sleep experts observe the secrets of the patients’ sleep problems first hand. But the investigations don’t stop there: the five contributors are also subjected to a night at the Goodnight Britain Sleep House, where every toss, turn and snuffle is monitored using state-of-the-art equipment while they sleep. Only then do the causes of their night-time traumas fully come to light and our experts can begin to devise a treatment plan that just might work.”

From the BBC website: http://www.bbc.co.uk/mediacentre/proginfo/2012/48/goodnight-britain-48.html

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As the clocks turned back and British Summer Time (BST) came to an end, millions across the UK enjoyed the benefit of an extra hour in bed. But for many women, this extra hour provided little relief, with a growing number now being diagnosed with the sleep disorder OSA (Obstructive Sleep Apnoea).

“A good night’s sleep is essential for our health and wellbeing. However, increasing rates of obstructive sleep apnoea amongst women are posing a significant threat to their quality of sleep, and potentially putting them at risk of serious health issues, including heart disease, stroke, depression and diabetes,” commented Judy Harris of the British Lung Foundation, which is campaigning for better awareness, diagnosis and treatment of people affected by OSA.

Traditionally viewed as a man’s disease, a recent study has suggested that among women aged 20-44, up to one quarter now have sleep apnoea, a figure which rises to more than half in women aged between 45 and 54, and 75 per cent in women aged between 55 and 70.

Whilst women have often been viewed as the ‘gatekeepers’ to their families’ health, and are often the first to recognise the signs and symptoms of sleep disorders in their husbands or bed-partners, increasingly they’re experiencing this debilitating disease for themselves, with symptoms including loud snoring, day time tiredness, poor concentration, headaches, depression and anxiety.”

With mounting evidence of sleep apnoea’s links to serious medical conditions, including cardiovascular disease and dementia, it’s vital that we move past the stereotypes that label OSA a ‘man’s disease’ and seek to raise awareness of this potentially deadly disease amongst women in the UK.

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A new study suggests that when prescribed by physicians in routine practise and used appropriately by patients, treatment for obstructive sleep apnoea (OSA) could reduce blood pressure in men with hypertension.

“All types of patients may benefit from this treatment, even those with other chronic medical conditions,” said Bharati Prasad, MD, MS, the study’s principal investigator. “It’s important to now do a prospective study enrolling different types of patients with sleep apnoea.”

The study, appearing in the issue of the Journal of Clinical Sleep Medicine, examined the effectiveness of obstructive sleep apnoea treatment on high blood pressure and diabetes control in 221 men with preexisting hypertension or type 2 diabetes and a new diagnosis of OSA. Participants received positive airway pressure (PAP) therapy upon treatment initiation.

Results show that both systolic and diastolic blood pressure decreased significantly with initiation of OSA treatment at both the first follow-up, 3-6 months after initiation, and the second follow-up, 9-12 months later.

According to the authors, this is the first study to examine the effectiveness of treatment of obstructive sleep apnea on routine measures of hypertension and diabetes control in a practise-based clinical setting. The results show the real-world effectiveness of OSA treatment on hypertension.

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The Daily Mail reports today that women who suffer from sleep apnoea during pregnancy are more likely to have babies who suffer from early health problems according to researchers.

They found babies of mothers with the breathing disorder had a greater risk of needing neonatal intensive care than unaffected mothers. Scientists from Case Western Reserve University in Cleveland studied obese pregnant women both with and without obstructive sleep apnoea. They found OSA was also associated with higher rates of pre-eclampsia in the overweight women.

The pregnancy complication causes high blood pressure and for protein to leak into the urine. If untreated it can develop into eclampsia, which is a type of life-threatening seizure. Lead author Dr Judette Louis, from the University of South Florida, said: “Our findings show that obstructive sleep apnea can contribute to poor outcomes for both obese mothers and their babies. Its role as a risk factor for adverse pregnancy outcomes independent of obesity should be examined more closely.”

Dr Louis and former colleagues from Case Western Reserve, analysed data for 175 obese pregnant women who had been tested for OSA at home using a portable device. Around 15 per cent of the participants had sleep apnoea. These women were heavier on average and more likely to have high blood pressure.

Around 42 per cent of women with sleep apnoea had pre-eclampsia compared to 17 per cent of those without the condition. Meanwhile nearly half (46 per cent ) of babies born to women with sleep apnoea needed intensive care treatment compared to 17 per cent of the other overweight mothers. Many of these admissions were due to respiratory distress.

Finally, 65 per cent of the women with sleep apnoea required a caesaeran section compared to a third of those without the condition. Premature birth rates were similar between the groups. Approximately one in five women are obese when they become pregnant in the U.S,  according to research from the federal Centers for Disease Control and Prevention. There are no stats available for the UK.

The study has been published online in the journal Obstetrics & Gynecology.

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