OSA

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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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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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Participants in the Wisconsin Sleep Cohort who self-identified as having asthma at the start of the research in 1988 had a 41% incident obstructive sleep apnea rate, compared with an obstructive sleep apnea incident rate of 29% among participants who did not report asthma at the beginning of the study, said Mihaela Teodorescu, MD, of the University of Wisconsin in Madison.

Of the 205 individuals who reported a history of asthma, 84 developed obstructive sleep apnea during the 8-year interval sleep studies, she reported at the annual meeting of the American Thoracic Society. Of the 1,278 individuals who entered the study without a self-report of asthma, 369 had developed incident obstructive sleep apnea after 8 years.

“There has been a body of evidence published suggesting that there is a relationship between obstructive sleep apnea and asthma,” Teodorescu told MedPage Today. “Each disorder makes the other worse, so understanding what starts this vicious cycle is very important. We asked the question of whether asthma promotes the development of obstructive sleep apnea.”

“In this cohort we found that having asthma at baseline predicted an increased incidence of obstructive sleep apnea 8 years later,” she said. “Overall, having any asthma at baseline predicted about a 72% higher likelihood of developing obstructive sleep apnea 8 years later.”

“Interestingly, when stratifying by the age of diagnosis, childhood onset of asthma was a higher predictor for development of obstructive sleep apnea, with an odds ratio of about 2.1,” she said in a press briefing following her poster presentation. “For each 5 years increment in duration of asthma, the likelihood of developing obstructive sleep apnea increased by 12%,” she said.

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The British Lung Foundation are carrying out the biggest ever survey of sleep apnoea sufferers in the UK. It asks people with OSA what they think about their condition and their treatment, and what they would like services to look like in the future for OSA patients. If you are a sufferer please take the time to contribute.

Complete the survey here

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Sleep deprivation is a significant hidden factor in lowering the achievement of school pupils, according to researchers carrying out international education tests.

It is a particular problem in more affluent countries, with sleep experts linking it to the use of mobile phones and computers in bedrooms late at night. Sleep deprivation is such a serious disruption that lessons have to be pitched at a lower level to accommodate sleep-starved learners, the study found.

The international comparison, carried out by Boston College, found the United States to have the highest number of sleep-deprived students, with 73% of 9 and 10-year-olds and 80% of 13 and 14-year-olds identified by their teachers as being adversely affected. In literacy tests there were 76% of 9 and 10-year-olds lacking sleep.

This was much higher than the international average of 47% of primary pupils needing more sleep and 57% among the secondary age group. Other countries with the most sleep-deprived youngsters were New Zealand, Saudi Arabia, Australia, England, Ireland and France. High-performing Finland is also among the most lacking in sleep. Countries with the best records for getting enough sleep include Azerbaijan, Kazakhstan, Portugal, the Czech Republic, Japan and Malta.

The analysis was part of the huge data-gathering process for global education rankings – the Trends in International Mathematics and Science Study (TIMSS) and Progress in International Reading Literacy Study (PIRLS).

Read the full BBC story

 

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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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This is the topic I will be addressing at:

The Nose: Recent Key Developments for ENT Surgeons

An event organised by my colleague Professor Ram Dhillon, and carrying an Accreditation of 3 hours CPD (ENT-UK). Other speakers and topics include:

Allergic rhinitis: is there anything new?
Mr Hesham Saleh, Consultant ENT SurgeonCharing Cross Hospital, London

Immunotherapy for ENT Surgeons. It’s not impossible to understand.
Dr Harsha Kariyawasam, Consultant Rhinologist, Royal National Throat Nose and Ear Hospital, London

Facial pain: a bane for ENT Surgeons. What are we doing wrong?
Mr Peter Andrews, Consultant ENT Surgeon, Royal National Throat Nose and Ear Hospital, London

For the future: Osteitis, Sinusitis: the modern theory for chronic sinusitis
Ms Claire Hopkins, Consultant ENT Surgeon, Guys & St. Thomas’ Hospitals

Biofilms in the nose: do they explain anything?
Mr James Fairley, Consultant ENT SurgeonWilliam Harvey Hospital, Kent

The event is being held on Thursday 11 April 2013 at The Courthouse Hotel, Great Marlborough Street, london

Download the flyer and booking form: ENT Nose Conference 11th Apr 2013

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Philips Electronics have announced the results of an extensive new scientific study into sleep apnea, conducted over the last two years by Philips in collaboration with University of Twente.The study, which surveyed 4,206 Philips employees in the Netherlands, revealed that 6.4% of them suffered from sleep apnea. A striking finding was that 78% of the people surveyed who reported symptoms of sleep apnea were entirely unaware that they were suffering from this sleep disorder.

Never before has research into sleep apnea been conducted among such a large group of people. 29% of all Philips employees in the Netherlands took part in the study, comprising men and women of different ages and levels of education, with different types of job and different cultural backgrounds. Previous screening studies were based on considerably smaller populations. For example, an often cited study published in 1993 examined a group of 602 people. It was estimated in this study that 2% of women and 4% of men in the middle-aged work force suffer from sleep apnea.

Piet-Heijn van Mechelen, Chair of Dutch patient organization ApneuVereniging and Project Leader for the survey, is pleased that the study has produced clear results. “Hundreds of thousands of people have symptoms but don’t know what the problem is,” he says. “This study provides valuable new insights into how often the condition occurs. And with the new screening method that was developed for this study, sleep apnea can be identified at an earlier stage and the quality of life of patients suffering from the condition can be greatly improved with treatment.”

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