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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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The widening American waistline may be feeding an epidemic of sleep apnoea, potentially robbing millions of people of a good night’s rest, a new study suggests.

The research didn’t definitively link the rise in obesity to sleep apnoea, and it only looked at 1 520 people, almost all white, in Wisconsin. But study author Paul Peppard believes the findings show a big spike in sleep apnoea cases over the past two decades – as much as 55% – and may translate to the entire United States.

“There are probably 4 million to 5 million people who are more likely to have sleep apnoea due to the obesity epidemic,” estimated Peppard, an assistant professor of population health sciences at the University of Wisconsin-Madison. “It’s certainly an uncalculated cost of the obesity epidemic, an epidemic of its own.”

The researchers looked at adults aged 30 to 70 who were monitored as they slept. About 600 to 700 underwent sleep tests between 1988 and 1994, with some continuing to take part along with hundreds of new participants from 2007 to 2010. The study considered the participants to have moderate-to-severe breathing problems if they had trouble breathing 15 or more times an hour while sleeping.

Sleep apnea is the main cause of breathing problems during sleep. People with the condition often have trouble staying in deep sleep because their throats close, blocking their airways and requiring them to partially awaken to start breathing properly. They don’t realise they’re waking up and may become very sleepy during the day. Besides sleepiness, sleep apnea can contribute to heart and other health problems if untreated and increase the risk of work- and driving-related accidents, according to the US National Heart, Lung, and Blood Institute.

The researchers extrapolated their findings to the entire United States and estimated that 10% of men aged 30 to 49 currently have symptoms of sleep apnoea. The study estimates the number is 17% of men aged 50 to 70. For women, the estimate is 3% among those aged 30 to 49 and 9% among women aged 50 to 70. Among all groups, heavier people were much more likely than thinner people to suffer from the symptoms.

The study estimates that these numbers have gone up by 14% to 55% from 1988-1994 to 2007-2010. Peppard estimated that 80% to 90% of the increase in symptoms is due to the growth in obesity. But it’s hard to know for sure how much of a role that obesity plays in causing more symptoms. While obesity is “almost certainly the biggest factor” in causing sleep apnoea, Peppard said, “there’s long list of things that cause sleep apnea or are related to sleep apnea, like being older, being male, having a narrower upper airway, having a genetic predisposition to it…”

Although the study tied obesity to higher risk of having sleep apnoea, it did not establish a cause-and-effect relationship.

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The 1Oth Middle  East Update in Otolaryngology – Head and Neck Surgery is the largest meeting of Otolaryngologists in the Middle East. I am delighted to have been invited back to speak for a second time about sleep apnoea, in a region where awareness of the condition is very low, but incidence is on the rise. The event is previewed in this month’s issue of Middle East Hospital magazine:

MEH March 2013 Middle East Otolaryngology article

Find out more here

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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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Although bariatric surgery results in greater weight loss than conventional measures, new research shows this does not translate into significantly greater improvement in obstructive sleep apnoea (OSA). Researchers from Monash University, the Alfred Hospital and Baker IDI Heart and Diabetes Institute conducted the first high-quality, randomised trial comparing the effect on OSA of surgical and medically-supervised weight loss in severely obese individuals.

The results, which show negligible statistical advantage of bariatric surgery in terms of treating OSA, are published in the Journal of the American Medical Association. Participants were recruited from sleep centres where they had been recently diagnosed with moderate to severe OSA and all had a Body Mass Index of between 35 and 55. Both groups – surgical and conventional weight loss – were followed up every four to six weeks for two years.

The participants who underwent laparoscopic adjustable gastric banding (LAGB) achieved an average two-year weight loss of approximately 20 per cent of their initial weight. The conventional group, who were provided with tailored dietary, exercise and behavioural programs, lost on average almost three per cent of their body weight over the two-year period. Associate Professor Dixon said the dramatic differences in weight loss were not reflected in improvements in OSA, which was comprehensively monitored using polysomnography.

“Both groups experienced a reduction in OSA severity, but the difference between the surgical group and the conventional group was surprisingly small, given the weight loss disparity, and the majority still needed their CPAP machines during sleep,” Associate Professor Dixon said. Our research confirmed that weight loss is associated with reduction in OSA, but it’s a complex relationship. The effects vary greatly between individuals. It seems that the largest improvement in OSA, is associated with mild to moderate, rather than extreme weight loss.”

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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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A very interesting post on CNN by Lisa Shives MD:

“The thin child with OSA does not usually act sleepy in the daytime. On the contrary, they often act hyperactive or inattentive. In fact, their symptoms can mimic attention deficit hyperactivity disorder. Large tonsils and adenoids are the primary cause of OSA in thin children because these and surrounding tissues can relax during sleep and block the airflow to the lungs. In fact, 80 to 90% of such cases of pediatric OSA are cured by surgically removing the tonsils and adenoids.

“Overweight or obese children are not such an easy fix. They usually present with loud snoring and significant daytime sleepiness. In obese children, the tonsils often become enlarged due to fatty tissues in the upper airway. Fat deposits in the neck and chest also add to the collapsibility of the upper airway during sleep.

“Unfortunately, a tonsillectomy/adenoidectomy is curative in only about 50% of overweight kids who have OSA. The others are encouraged to try continuous positive airway pressure (CPAP) which is the most common treatment for severe OSA.”

Read full post…

 

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A new study published in the European Respiratory Journal has found that a Mediterranean diet coupled with increased exercise and continuous positive airway pressure (CPAP) therapy may help to treat sleep apnoea.

The researchers, from the University of Crete in Greece examined 40 obese patients suffering from OSAS. Twenty patients were given a prudent diet to follow, while the other 20 followed a Mediterranean diet. Both groups were also encouraged to increase their physical activity, mainly involving walking for at least 30 minutes each day. In both groups, the patients also received CPAP  therapy, which involves wearing a mask that generates an air stream, keeping the upper airway open during sleep.

The results showed that people following the Mediterranean diet had a reduced number of disturbances, known as apnoeas, during the rapid eye movement (REM) stage of sleep, which usually accounts for approximately 25percent of total sleep during the night. The findings also revealed that people following the Mediterranean diet also showed a greater adherence to the calorie restricted diet, an increase in physical activity and a greater decrease in abdominal fat.

The researchers suggested that further studies in a larger sample are required to fully understand the benefits of this diet.

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In Wales on Sunday Dr Keir Lewis, a consultant at Prince Phillip Hospital, Llanelli, and head of the sleep service for Hywel Da Health Board, said the number of people suffering from conditions such as obstructive sleep apnoea (OSA) has risen dramatically in the past 10 years – putting severe strain on the NHS. He also correctly highlights the fatal risk to drivers of this condition, and gives some shocking examples.

Dr Lewis said one of the major problems faced and posed by OSA suffers was their fitness to drive. “We know from US-Canadian insurance claims and driving simulators that untreated people with OSA are five to seven times more likely to suffer a road crash. It’s one of the few conditions that kills people other than the sufferer. I’ve had someone coming in with severe symptoms of OSA but didn’t realise it until the police were called when someone spotted him driving straight across a roundabout. When we monitored his sleeping he was actually stopping breathing 140 times in an hour.”

“I also had a man fall asleep while he was operating a crane and it was only when he fell out and landed in water did he wake up and realised how severe his problem was. And we have treated other people who have fallen asleep behind the joystick of a plane and someone who fell asleep pouring molten metal. It was when he was on the burns unit, that the staff noted him stopping breathing.”

Employing the emergency services to a fatal road accident on a motorway costs taxpayers about £250,000 – the amount Dr Lewis said is enough to run an OSA service for a year – and the risk of accidents is increasing as the population gets more obese. Dr Lewis said: “We think about 80% of people who suffer from OSA are still undiagnosed and even the 10% to 20% who get diagnosed take about eight to 10 years from onset of symptoms to eventual treatment. Because it is a gradual condition people don’t necessarily realise why they are feeling like they do and blame age.”

Take the Snore Centre sleep apnoea test to see if you could be a sufferer

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The BBC reported last week that the NHS is struggling with a “tidal wave” of sleep disorders related to obesity, according to specialists. They report that the number of people being referred for sleep problems in Scotland has risen 25% over the past three years, with about 80% of patients being overweight. Figures for the rest of the UK are not available but doctors at sleep clinics in Scotland say their experience is probably mirrored elsewhere. The DVLA estimates 20% of serious incidents on major roads are caused by sleepy drivers.

Dr Tom Mackay, an expert in sleep disorders, at the Royal Infirmary of Edinburgh says he is facing a “tidal wave” of cases. There are now more new cases of sleep apnoea being diagnosed than lung cancer and emphysema combined. Dr Mackay said: “Over the past five to 10 years we have noticed quite a rise in the number of people being referred to us. That rise seems to be accelerating. We are now seeing 2,500 new patients each year. We are reaching capacity in terms of what we can cope with, and there is an undoubted link with people’s weight. For a man, if you’ve got a collar size of more than about 17.5in (44cm) then that is a marker for too much flesh around your neck. That roughly equates to a waist size of about 36in.”

Dr Mackay urged anyone who thinks they may be suffering from sleep apnoea to get properly diagnosed. The DVLA does not usually remove the driving licence of patients who are undergoing treatment.
Meanwhile the British Lung Foundation is so concerned about the steep rise in cases that it has made sleep disorders a priority for action.

The BBC has made this video report on one patient’s success in beating sleep apnoea through losing weight.

 

 

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