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Sleep apnea is common in people with multiple sclerosis and may contribute to their fatigue, a new study shows. Fatigue is one of the most frequent and debilitating symptoms experienced by MS patients. The study included 195 people with MS who completed a sleep questionnaire and were assessed for daytime sleepiness, insomnia, fatigue severity and sleep apnea.

One-fifth of the patients had been diagnosed with sleep apnea and more than half were found to have an elevated risk for the condition. The researchers also found that sleep apnea risk was a significant predictor of fatigue severity.

MS is a chronic, frequently disabling disease that attacks the central nervous system, according to the National Multiple Sclerosis Society. Symptoms range widely, from mild signs such as numbness in the limbs to severe symptoms including paralysis or loss of vision.

The new findings suggest that sleep apnea may be a common but under-recognized contributor to fatigue in MS patients, and doctors should not hesitate to check these patients for sleep problems, study author Dr. Tiffany Braley, an assistant professor of neurology at the University of Michigan Multiple Sclerosis and Sleep Disorders Centers, said in an AASM news release.

“Obstructive sleep apnea is a chronic illness that can have a destructive impact on your health and quality of life,” and MS patients at high risk for sleep apnea should undergo a comprehensive sleep evaluation, academy president Dr. M. Safwan Badr said in the news release.

The study appears in the Feb. 15 issue of the Journal of Clinical Sleep Medicine, an AASM publication. About 400,000 people in the United States have MS, according to the National Multiple Sclerosis Society. Up to 7 percent of men and 5 percent of women have sleep apnea, according to the AASM.

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Sleeping Disorders Centre founder, Consultant ENT surgeon Michael Oko, will address senior international healthcare executives, public servants, and academics at the 1st International Road Traffic Accident Conference at the Rose Wood Hotel, Abu Dhabi, on 11th March 2014.

Mr Oko, a UK government advisor on Obstructive Sleep Apnoea (OSA) strategy, will be speaking about the benefits of preventative treatment in reducing road traffic accidents, using the example of Lincolnshire UK, where traffic fatalities have fallen significantly since sleep apnoea testing and treatment began. Professor Ram Dhillon (Middlesex University and Sleeping Disorders Centre) will also address the conference on “Snoring & Preventable Deaths on the Road: A Common, medically treatable, and often missed cause of Road Traffic Accidents.”

Mr Oko said:

“It is suspected that about 20% of car accidents are sleep related and research has shown that sleepiness can impair driving more than drink! Indeed, patients with OSA have a 7-12 fold chance of a road traffic accident (RTA) compared to those who do not, and results in Lincolnshire have shown that treating the condition can reduce the accident rate dramatically. With the low level of awareness of sleep apnoea in the Middle East it’s no surprise that road accident rates in the Gulf region are high. In fact, road traffic accidents are the second major cause of death in the UAE and there are 3500 fatalities per year from RTAs in Saudi Arabia alone. I believe that the success I have had in Lincolnshire can be replicated in the Middle East by raising awareness of the condition, and forming long-term partnerships with local hospitals, doctors, and government departments.”

Mr Oko has already been very active in bringing this message to the healthcare community in the Middle East. For his work in this area Mr Oko was awarded the Middle East Hospital magazine award for excellence in respiratory care in 2011 and 2013.

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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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The severity of sleep apnoea can independently predict the aggressiveness of malignant skin melanoma, according to a new study.

The research, presented at the European Respiratory Society (ERS) Annual Congress, adds new evidence to a number of studies that have found a link between cancer and the sleep disorder.

Previous studies have looked at a link between sleep apnoea and both mortality and incidence rates from cancer. Some experimental studies in mice have also shown that reduced oxygen levels in the blood, which is common in sleep apnoea, enhanced tumour growth. This is the first study in humans to look at the link between a specific type of cancer (skin melanoma) and sleep apnoea.

Researchers studied 56 patients diagnosed with malignant skin melanomas. They measured the aggressiveness of the cancer along with the presence and severity of sleep apnoea.

60.7% of the patients had sleep apnoea and 14.3% had severe sleep apnoea. The results found that the melanoma was more aggressive as the severity of sleep apnoea increased. This was the case for all three measurements for sleep apnoea severity. The severity measurements were also linked with other factors of aggressiveness, including the growth rate or the depth of invasion of the tumour.

Lead author, Dr Francisco Campos-Rodriguez, from the Hospital de Valme in Seville, Spain, said: “This is the first study in a human sample to show that sleep apnoea can worsen the outcomes of melanoma. The findings are from a preliminary small sample, but if the results are confirmed in larger studies, this would have important clinical implications, particularly as sleep apnoea can be easily treated and this could open up new therapeutic possibilities for people with both conditions. We have just begun a bigger prospective trial enrolling 450 patients with cutaneous melanoma to analyse this link further.”

 

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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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Science Nordic reports ona new which study reveals that children with obstructive sleep apnoea have a 6.5 times higher mortality rate than other children. Children who suffer obstructive sleep apnoea experience repetitive pauses in breathing during sleep. This interrupts their sleep, which can lead to irritability, poor concentration and slower growth. However, these children often have other and more serious ailments to deal with.

”This is the first systematic study of mortality after children have been diagnosed [with obstructive sleep apnoea], and we were surprised to see that it was this high,” says the lead author of the study, Professor Poul Jørgen Jennum, the head of research at the Clinical Neurophysiological Research Unit at Glostrup Hospital, Denmark.

“Our study also shows that children with sleep apnoea are more prone to illness – both before and after being diagnosed.”

Sleep apnoea can occur on its own, but it is frequently described as an ‘accompanying disease’, as it is often accompanied by other serious diseases. This is one of the reasons why it is so hard to figure out why these children lose their lives. We know that sleep apnoea in itself is dangerous, but often there are other diseases too, and that may be where the explanation for the high mortality rates can be found.

“We cannot say with certainty what it is that kills these children,” says Jennum. “We know that sleep apnoea in itself is dangerous, but often there are other diseases too, and that may be where the explanation for the high mortality rates can be found.”

Obesity has become an increasingly prevalent cause of sleep apnoea. In rare cases, sleep apnoea is caused by neurological or genetic disorders, he explains. Children with sleep apnoea often experience learning difficulties and an erratic appetite as a consequence of the constant interruption of their sleep.

Since they rarely or never reach REM sleep, they do not produce sufficient amounts of growth hormones. This is why they are usually shorter, on average, than other children. The long pauses in breathing also strain the heart and may in the worst case cause brain damage. If the underlying cause of the sleep apnoea can be removed, the children will grow taller.

“Our study suggests that many children with sleep apnoea are probably not being diagnosed and treated correctly,” says Jennum.

The study is published in the journal Thorax.

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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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