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Writing in Arab News, leading sleep apnoea expert, Professor Ram Dhillon of the Sleeping Disorders Centre, spells out the dangers of sleep apnoea. Professor Ram Dhillon and his colleague, Sleeping Disorders Centre founder Michael Oko, will be speaking at the 1st International Road Traffic Accident Conference being held in May 2014 in Abu Dhabi, UAE.

“Untreated or inadequately treated OSA is associated with major medical problems. If one considers the OSA event as a strangulation leading to poor oxygen levels to every cell in the body it is easy to understand the detrimental consequences. It may lead to high blood pressure, cause a pre-diabetic state and make existing diabetes more difficult to manage. There is an increased incidence of heart problems such as heart attacks and heart rhythm disorders. There is also an increased likelihood of suffering a stroke and the kidneys can also be damaged. Studies reveal untreated severe OSA will lead to death in 15% of patients and a major heart event in 30 percent over a 12-year period.

“There is an increasing awareness of the relationship between OSA and falling asleep during the boredom of driving, particularly on long straight roads. This is an issue for all road users but is likely to be a much greater problem in the haulage industry.”

• Professor Ram Dhillon is the consultant surgeon at Middlesex University, School of Health and Social Sciences, London. Michael Oko, consultant surgeons and Department of Health Adviser on Sleep Apnea, UK National Health Service, also contributed to this report.

Source: Arab News

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The risk of death goes up with the severity of a person’s obstructive sleep apnea, according to a new study in Korea.

The Journal of Clinical Sleep Medicine study is the first to find that sleep apnea severity is linked with death risk in an Asian population, said researchers from Chosun University Hospital, Seoul National University College of Medicine and the Seoul National University Bundang Hospital. Previous studies had only looked at Western populations.

Researchers analyzed data from 2,240 people ages 40 and older with sleep apnea or snoring who visited the Sleep Center of Seoul National University Bundang Hospital at some point between 2003 and 2009. All the study participants underwent a full-night polysomnography testing, through which researchers were able to deduce the number of times they stopped breathing throughout the night due to their sleep apnea. They were then grouped into categories based on sleep apnea severity (no sleep apnea, moderate sleep apnea, moderate sleep apnea and severe sleep apnea).

All the participants who had at least mild sleep apnea (about 1,800 of the participants) were assigned to undergo surgery, CPAP, a mandibular advancement device, or a combination of the three.

The participants were followed up with until Dec. 31, 2011; the average participant was observed for 61.4 months, or a little more than five years. Of those with at least mild sleep apnea, 735 received treatment for the condition; the other 1,065 were not treated either because they refused treatment, they became lost during the follow-up period, they wanted to try losing weight, or they wanted to try sleeping in a different position.

Over the study period, 69 people (3.08 percent of the study group) died. Researchers found that the death rate was higher in the groups of people with more severe sleep apnea, compared with less severe or no sleep apnea. Specifically, 1.81 percent of people with no sleep apnea died over the study period, 2.18 percent of people with mild sleep apnea died, 3.54 percent of people with moderate sleep apnea died and 4.2 percent of people with severe sleep apnea died. Heart disease and strokes were the cause of about a third of the deaths.

Overall, the risk of dying was 2.47 times higher among people with severe sleep apnea compared with people without sleep apnea.

Source: Huffington Post

 

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This conference aims to raise the profile of the preventability of road traffic injuries and promote good practices in order to achieve safe roads, safe speeds, safe vehicles, and safe people.

The Lincolnshire experience

In 2002 they were 104 fatal car accidents in Lincolnshire with a population of 700,000, so the Road safety Partnership (consisting of The NHS, Police and local Council) was formed to try and address and reduce this carnage on the roads. It was successful in reducing this figure to 79 per annum by a concerted effort to raise driver awareness via media messages with a budget of £3 million per annum, but seemed to stall at this figure.

In Lincolnshire we had a perfect storm of (similar in many respects to UAE):

(1) No existent service,

(2) The most obese population in Europe,

(3) Hazardous or dangerous roads

(4) No rail or other transportation infrastructure of note. 

In 2006 an ObstructiveSleepApnoeaservice was commissioned (it affecs 4-6 % of the population) to treat all the drivers that may fall asleep at the wheel and by 2008 fatal RTAs caused 52 deaths per annum and by 2012 it was 39 per annum.

This approach can also be successful in UAE

Sleep apnoea potentially affects 20% of UAE population, It could be responsible for a high number of car accidents, so if it is properly treated there should be a big reduction in car fatalities.

The conference is an important forum to inspire and connect leaders, decision makers, Health professionals, public servants, academics and advocates, bringing International keynote speakers and participants to seek, develop, and exchange views on what works to prevent road traffic accidents and how best to bring it to fruition in policy and practice for government and the private sector

1st International Road Traffic Accident Conference
21-22 November 2013
Emirates Palace Hotel, Abu Dhabi, UAE
www.menaconf.com

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Medical Xpress reports that women diagnosed with gestational diabetes are nearly seven times more likely to have obstructive sleep apnoea than other pregnant women, according to a recent study accepted for publication in The Endocrine Society’s Journal of Clinical Endocrinology & Metabolism (JCEM). Gestational diabetes causes glucose levels in the bloodstream to rise above normal levels. This form of diabetes occurs during pregnancy, typically in the second trimester. Between four and eight of every 100 pregnant women in the United States develop gestational diabetes.

The new study found a link between gestational diabetes and sleep apnoea, which causes brief interruptions in breathing during sleep. If sleep apnea goes untreated, it can raise the risk for stroke, cardiovascular disease and heart attacks.

“It is common for pregnant women to experience sleep disruptions, but the risk of developing obstructive sleep apnea increases substantially in women who have gestational diabetes,” said Sirimon Reutrakul, MD, who conducted the research at Rush University Medical Center in Chicago. “Nearly 75 percent of the participants in our study who had gestational diabetes also suffered from obstructive sleep apnoea.”

In a series of observational case control studies, researchers monitored 45 women for sleep apnoea and other sleep disruptions. The research examined sleep health in 15 pregnant women who had gestational diabetes, 15 pregnant women who did not have the condition and 15 women who were not pregnant and did not have diabetes.

The study found a strong association between obstructive sleep apnoea and gestational diabetes in this group of mostly overweight or obese women. Pregnant women who did not have gestational diabetes were able to get an additional hour of sleep and had less fragmented sleep than women who had gestational diabetes. Past research has shown lost sleep, fragmented sleep and shorter periods spent in deep sleep – all symptoms of sleep apnoea – are likely to raise the risk a person will develop diabetes.

“Based on these findings, women who have gestational diabetes should be considered for evaluation for obstructive sleep apnoea, especially if other risk factors such as hypertension or obesity are present, and women already diagnosed with sleep apnoea should be monitored for signs of gestational diabetes during pregnancy,” Reutrakul said.

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New research published in the American Journal of Physiology – Regulatory Integrative and Comparative Physiology, suggests the estimated 12 million Americans who have obstructive sleep apnea should take better care to sleep in a very dark room. Scientists at The Ohio State University Wexner Medical Center have found exposure to dim light at night can interact with sleep apnea and lead to increased levels of depression and anxiety in mice.

“Although it is unclear at the present time whether sleep apnea causes depression, both conditions are commonly seen together in patients. Our research suggests that sleeping even with a minimum amount of light may increase symptoms of depression in those with sleep apnea,” said Dr. Ulysses Magalang, director of Ohio State’s Sleep Disorders Center and a co-author of the study.

The study involved mice that were placed in sleep apnea-like conditions that mimic the repetitive lowering of oxygen levels that sleep apnea patients experience. Half were kept in normal lighting conditions during the day and total darkness at night. The other half was exposed to dim light at night using a 40-watt light bulb in the lab. The group in dim light had higher anxiety behaviors and more depressive behaviors than the mice kept in the dark environment. Scientists also observed impaired learning and memory among both sets of mice.

“Not only were these changes observed during field and maze tests, but we also recorded physical changes, including a reduction of cell size in the hippocampus, an area of the brain important in memory and spatial navigation,” said Taryn Aubrecht, first author of the study and a neuroscience graduate student at Ohio State. “The combination of dim light exposure and sleep apnea appears to result in increased depressive and anxiety-like behaviors in mice, so limiting exposure to light at night could be a very simple strategy to help patients with sleep apnea,” Magalang said. “We’re currently exploring further human testing.”

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An Australian study at Royal Melbourne Hospital has found a link between epilepsy and obstructive sleep apnoea (OSA). OSA is a type of ‘sleep-disordered breathing’. It is when a person has problems breathing while they are asleep, caused by obstruction (blockage) of the airway.

Previous research has suggested that people with epilepsy have a higher risk of sleep-disordered breathing than other people. Some people also experience weight-gain as a side-effect of epilepsy medication – which can also increase this risk.

Prof Terry O’Brian and his team recruited 87 people with epilepsy and monitored their sleep patterns. In the general population, between three and seven per cent of people experience sleep-disordered breathing. Of the 87 people with epilepsy studied, 22 per cent (almost a quarter) had trouble breathing that was severe enough to need treatment.

Fortunately, treating OSA is relatively simple. The people experiencing OSA were given a continuous positive airway pressure (CPAP) device to wear during sleep. The device maintains a steady pressure that prevents disordered breathing.

Prof O’Brian said in a press release: “It is important to diagnose [OSA] in patients with epilepsy, as treatment with CPAP can improve sleep quality and seizures, and associated problems like day time drowsiness, difficulty concentrating and cardiovascular disease, often without the requirement of medication.”

The full study findings were published in an online edition of Epilepsy Research on 27 March.

Source: Epilepsy Today

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Fleet News reports that the DVLA has produced a document highlighting the facts around driving and obstructive sleep apnoea syndrome.

The condition is particularly prevalent among HGV drivers, and excessive sleepiness is thought to be responsible for up to 20% of motorway traffic accidents. The document, which has been developed between the OSA Partnership Group and the DVLA, has taken into account input from clinicians and the haulage industry itself.

Professor John Stradling from the Oxford Sleep Clinic, who contributed to the document, said: “It is vital that we do not push the problem underground by making it difficult for commercial drivers to admit that they have symptoms. Therefore members of the OSA Partnership Group have worked closely with the DVLA to agree a consistent process that highlights the importance and the longer term benefits of seeking treatment quickly.”

Those most at risk of having the condition are overweight middle-aged men and HGV drivers seem to be at higher risk of OSAS. However, OSAS can be fully treated quickly and easily; when the symptoms are controlled, quality of life can improve considerably. However if left untreated OSAS is likely to impact on overall health and wellbeing, and can impact on life expectancy. Ian Gallagher, head of policy for DVLA Policy at FTA said: “We understand from talking to our members that many drivers have concerns about seeking medical advice for fear of losing their licence. However this document provides answers to many questions about OSAS and also offers advice on how to access treatment as quickly as possible.”

The OSA Partnership Group has been established to bring together organisations from the commercial vehicle sector, clinicians, patient groups and those interested in health and safety at work together to raise awareness of sleep apnoea and to address the road safety issues associated with the condition.

Jan Chandaman, acting head of medical licensing policy at the DVLA said: “Our medical team has worked closely with the OSA Partnership Group in order to provide answers that we hope will allay drivers’ concerns if they believe they have symptoms of OSAS, and to encourage early notification of the condition.

“Our concern, first and foremost, has to be the safety of road users – both drivers and others and we want drivers to come forward straight away if they have any symptoms of the condition. Once they are receiving treatment and their symptoms are brought under control, driving can resume without jeopardising their safety and that of other road users. There is a European Working Group in progress on OSA and OSAS which DVLA is a member of and we are awaiting their recommendations on European standards for this condition.”

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WebMD reports on a new study published in the BMJ in which researchers took a close look at the effect of poor sleep on the chance of work-related injuries. They pooled the results of 27 studies, which included more than 268,000 working adults. Through interviews, questionnaires, and doctors’ diagnoses, the studies identified which people had sleep problems. The researchers then looked at whether workplace injuries were more likely among people with sleep difficulties than among those without these problems.

The researchers found a strong link between sleep problems and work injuries. People with sleep difficulties were around 60 percent more likely to have an injury at work than those without these problems. Overall, the researchers estimated that 13 in every 100 work injuries were related to poor sleep.

When the researchers looked at different types of sleep problems, they found that people who had sleep apnoea or took sleep medicines had the highest chance of work injuries. Perhaps surprisingly, the risk of injury related to poor sleep was lower for workers in industrial jobs and other physically demanding work (such as farming, mining, and building) than for workers overall.

This was a well-conducted review of studies, and it should provide a reliable summary of what the current research tells us about sleep problems and work injuries. However, it’s worth noting that the review didn’t include studies looking at poor sleep and driving-related work injuries. If these studies were included, the overall risk of work injuries related to poor sleep could be even higher.

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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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Snore Centre eNewsletter May 2013

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