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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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Snore Centre eNewsletter May 2013

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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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An online survey conducted by the Sleeping Disorders Centre has found that almost three quarters of respondents were at a high risk of suffering from sleep apnoea. Half of the 52 respondents were classified as obese (with a BMI over 35), a key indicator of risk, 69.2% said that they snored loudly, and 92.2% complained of feeling tired during the daytime. 55.8% of all respondents to the survey were men, who traditionally have a higher risk level than women, although recent evidence suggests this gap is closing.

Michael Oko, consultant ENT surgeon, and Sleeping Disorders Centre founder, said:

“Sleep apnoea prevents people from getting a good night’s sleep by preventing air getting to the lungs. This leads to tiredness and irritability, and marital problems, and can also contribute to serious illnesses such as diabetes, hypertension and heart disease. Once people are aware they are suffering from the condition there are various treatments that can help them to overcome it, the most common being wearing a Continuous Positive Airway Pressure (CPAP) mask at night.”

Mr Oko, who recently appeared as an expert on a BBC1 programme about sleeping disorders “Goodnight Britain”, actively campaigns to raise awareness of sleep apnoea and writes a regular blog on the subject. He will be addressing the 10th Middle East Update in Otolaryngology in Dubai on 21st April 2013. He added:

“Almost all the survey respondents felt tired during the day, and must have suspected a sleeping disorder to have visited the site and completed the survey. I hope that more and more people will take this test and get help if they need it, as the survey shows; if you think you may have a sleeping disorder, the chances are that you do.”

Visitors to the Sleeping Disorders Centre website were asked to complete the STOP-BANG questionnaire, a set of eight questions regarded as the most accurate means of indicating a person’s level of risk of suffering from sleep apnoea from a self-conducted survey. Answering yes to three or more of the eight questions (measuring BMI, age, sex, neck size, snoring, fatigue, blood pressure, and observed apnoeas) indicates a high risk and that the person should visit their GP or go to a sleep clinic for an assessment.

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The British Lung Foundation is running a campaign to raise awareness of sleep apnoea. In their10-point OSA Charter, they call on governments across the UK to take action so that people with OSA and their families get the support and treatment they need.

You can help to make a difference! by completing this online form on the BLFs website, you can tell your elected representative why it is important to take action on OSA to bring about earlier and better rates of diagnosis, and to secure better care and treatment for all those with the condition.


The OSA Charter

The British Lung Foundation…

Believes that people with OSA and their families have a right to:
1. OSA screening, through primary care wherever possible;
2. a speedy and accurate diagnosis in a sleep clinic, wherever they live in the UK;
3. access to appropriate treatment and to a comprehensive specialist sleep service if needed, wherever they live in the UK;
4. appropriate information and ongoing support for the management of the condition, according to agreed national standards and provided by suitably qualified and trained staff; and
5.timely and relevant information on the implications of an OSA diagnosis for vigilance-critical job roles, and fast-tracking for diagnosis and treatment if people with OSA drive for a living.

Calls on governments across the UK to:

6. make OSA a national priority;
7. increase awareness of the symptoms and dangers of, and issues that surround, OSA among medical professionals, employers, the general public and those at greatest risk;
8. ensure collection of comprehensive data to enable commissioners and service planners to provide effective services; and
9. encourage investment in research, including clinical trials, recognising the potential cost savings and improvements to quality of life that could be made.

And encourages employers to:

10. arrange for all staff who are employed as drivers or in other vigilance-critical roles to be screened for OSA.

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Untreated severe obstructive sleep apnea (OSA) is associated with an increased risk of cardiovascular mortality in the elderly, and adequate treatment with continuous positive airway pressure (CPAP) may significantly reduce this risk, according to a new study from researchers in Spain.

“Although the link between OSA and cardiovascular mortality is well established in younger patients, evidence on this relationship in the elderly has been conflicting,” said lead author Miguel Ángel Martínez-García, MD, of La Fe University and Polytechnic Hospital in Valencia, Spain. “In our study of 939 elderly patients, severe OSA not treated with CPAP was associated with an increased risk of cardiovascular mortality especially from stroke and heart failure, and CPAP treatment reduced this excess of cardiovascular mortality to levels similar to those seen in patients without OSA.”

The findings were published online ahead of print publication in the American Thoracic Society’s American Journal of Respiratory and Critical Care Medicine.

All subjects in this prospective, observational study were 65 years of age or older. Median follow-up was 69 months. Sleep studies were conducted with either full standard polysomnography or respiratory polygraphy following Spanish guidelines. OSA was defined as mild-to-moderate (apnea-hypopnea index [AHI] 15-29) or severe (AHI ≥30). Patients with AHI <15 acted as controls. CPAP use ≥4 hours daily was considered as good adherence to treatment.

Compared with the control group, the adjusted hazard ratios for cardiovascular mortality were 2.25 (CI, 1.41 to 3.61) for patients with untreated severe OSA, 0.93 (CI, 0.46 to 1.89) for patients treated with CPAP and 1.38 (CI, 0.73 to 2.64) for patients with untreated mild-to-moderate OSA. Similar results were observed among the subgroup of patients ≥75 years of age. Among patients who initiated CPAP treatment, compliance was independently associated with a reduced risk of cardiovascular mortality.

The study had a few limitations, including that the study was not randomized, the reduced statistical power in the subgroup analyses, and the use of respiratory polygraphy to diagnose OSA in a number of patients. Strengths included being the large study size including exclusively elderly patients and the long follow-up.

“This is the first large-scale study to examine the impact of OSA on cardiovascular mortality in a series including exclusively elderly patients and assess the effectiveness of CPAP treatment in reducing this risk,” said Dr. Martínez-García. “Our finding that adequate CPAP treatment is associated with significant reductions in cardiovascular mortality in patients with OSA has important implications, especially given the increasing elderly population.”

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Well I had to just put pen to paper about my care and treatment to try and give a bit of hope to anyone that is struggling. I started on CPAP about 7 months ago. At first I was given a normal CPAP machine and full face mask.  Things did not go too well and I kept going back to my local sleep clinic. The sleep tech was really good and helpful, she did all she could to help me, she sent me home with an APAP to see what pressure my normal  machine needed setting at.

I had it for 2 nights and these where the only 2 nights I had any sleep at all!!! During my time struggling I had to go off work sick, as it made me so down, and I could not think what I was doing . I asked about seeing if there was any chance getting an APAP, but this area does not prescribe APAP and seeing as I had only had used one for 2 nights I was unsure if it was all in the mind !!! I used my CPAP every night without fail for at least 4 hours but I was just feeling worse and worse.

I was due to go and see the specialist and I was at my wits end as I had been trying for about 20 weeks. I am a fighter but by this time I was in bits and unable to think about anything, so I came off my CPAP thinking that in 2 weeks’ time I was seeing the specialist and I would get some help!!!!! Little did I know what was going to happen!! I saw the so-called sleep consultant for this area he basically he told me that there was nothing he could do!!!!!

He said I was suffering from insomnia and needed to see a  psychologist . Then he looked in down my  throat said I could not have an operation to help me because I had too much fat, and because I had not used my machine for the last 2 weeks he wanted it back and asked if I had got it with me !! So the next day I went to hand it back in, all the time knowing that I needed something. I was totally gutted, it was like sending me home with a ticking time bomb!!!

For the next few weeks I just thought sod it, I will just not have any treatment. But Kath Hope from hope 2 sleep suggested going back to my GP and maybe seeing someone else. After talking to Roz, who had already been treated, shetold me about Mr Oko at Boston. He was  3 hours drive from where I live but it was well worth going to see him. He gave me an APAP machine due to my sleep test results, along with a Respironics Blue Gel mask. That was 5 weeks ago and since then I have used  the APAP every night and I am sleeping for about 7 to 8 hours. As the days go on the more happier I am with it.

I have not felt like this for over 15 years. During this time I have had depression and was nearly sectioned. I also suffer with fibromyalgia, and the last few days these things have improved so much so that in time I will hopefully be able to come off my medication.  So never give up, there is always someone out there that can help, you just have to find the right specialist.  I got my appointment to see Mr Oko within a approx. a week and attended his clinic a few weeks later.

Before you go in to see Mr Oko you see a nurse who tells you every thing you need to know about sleep apnoea, which also puts you at ease. I cannot say how grateful I am to Mr Oko and his team for their help. If I had gone on with no treatment I dread to think what would have happened to me. I already feel that I’ve had at least 15 years of hell due to sleep apnoea. I want to say thank you to you all at Boston and thank Mr Oko for giving me a life again. The other 2 people i have to thank are Kath Hope from hope 2 sleep and Roz for getting me to see Mr Oko.

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The Department of Health has set up a Obstructive Sleep Apnoea  (OSA) Working Group with a brief to produce a report outlining recommendations for the Department of Health’s (DH) Respiratory Programme Board on a clinically effective strategy to improve outcomes for adults with obstructive sleep apnoea (OSA) from April 2013.

Consultant ENT surgeon, and founder of the Sleeping Disorders Centre, Michael Oko, welcomed the formation of the working group:

“I am looking forward to contributing to the work of DH in this important area. Awareness of sleep apnoea and its associated risks has been historically low, with many sufferers undiagnosed. However, evidence shows that the condition is widespread with around 4% of the population affected, and there is a growing body of evidence linking the condition to an increased risk of stroke, heart failure, diabetes, and other serious illnesses. The rising tide of obesity and cardiovascular disease, coupled with the increasing public awareness of sleep apnoea, will mean that diagnosis of sleep apnoea is set to keep rising and we will need to have a strategy in place to cope with this growth in demand for sleep apnoea services in the UK”.

The terms of reference of the working group, which met for the first time on 19 July, include identifying the quality and economic costs to the NHS of the burden of OSA; reviewing current initiatives and incentives to improve the quality of care for people with OSA; prioritising interventions that will have the most impact on improving quality, outcomes and procurement of equipment; highlighting the impact of OSA on patients with co-morbidities including those with hypertension, obesity, stroke, cardiovascular disease, heart failure and diabetes; and to align development of the strategy with the objectives of the Outcomes Strategy for COPD and Asthma and existing work undertaken by the BLF, BTS, ARTP Sleep and British Sleep Society.

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Patients seen at the Cleveland Clinic Sleep Disorders Center who used positive airway pressure (PAP) to treat their obstructive sleep apnea (OSA) had improvements in their depressive symptoms, even if they followed the prescribed PAP regimen only partly, a new study reports.

The study looked at 779 patients with OSA and asked them to fill out a standardized PHQ-9 form to assess depressive symptoms, which patients with OSA often have, researchers said. They were assessed again with the PHQ-9 following PAP treatment, and all showed improvement in PHQ-9 scores; however, patients using their PAP devices more than four hours per night had greater score improvements than those who were less adherent. Other factors that affected the improvements in PHQ-9 scores were whether the patient was sleepy and marital status.

“The score improvements remained significant even after taking into account whether a patient had a prior diagnosis of depression or was taking an anti-depressant,” said Charles Bae, MD, principal investigator in the study. “The improvements were greatest in sleepy, adherent patients but even non-adherent patients had better PHQ-9 scores. Another interesting finding was that among patients treated with PAP, married patients had a greater decrease in PHQ-9 scores compared to single or divorced patients.”

Source: American Academy of Sleep Medicine

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