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The Wellcome Trust produced this video in 2009, and its well worth watching for anyone wanting know the basics of sleep apnoea. The Trust’s aim with this video was to explain the condition and treatment, but also to put a spotlight onto the work of Dr Mary Morrell, who studies the condition. At the time of filming she was about to embark on a major new trial in the elderly, for whom this problem is very common.
A very interesting post on Fierce Healthcare blog about the link between patient satisfaciton and profit in the US. This is also highly relevant to the way the NHS is going. When revalidation comes doctors will be judged on how happy their patients are, and patients will choose doctors with the best track record.
“Hospitals with high performance scores in patient care are more profitable, according to a new Press Ganey report. The top 25 percent of U.S. hospitals with the highest scores on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) question about performance were, on average, the most profitable and had the highest clinical scores, suggesting that patient experience, coupled with clinical outcomes, can mean financial profitability for the institution.
“It is interesting to note that the only hospitals that showed a positive profit margin were those that were highly rated by their patients,” the report states. “…Although there is not a lot of difference in the clinical measures among the four groups of hospitals segmented on patient rating score, the top quarter of hospitals based on HCAHPS overall rating score also have the highest average clinical score. Taken together, these [results] suggest that excellence in patient experiences, clinical outcomes and financial profitability often occur together.”
A growing body of research has also found that sleep apnoea can be a drain on intimacy, causing erectile dysfunction in men and loss of libido in women.
Scientists suspect this may have to do with sex hormones like testosterone, which rise with sleep and fall when there is a lack of it. Because it causes intermittent waking and chronic sleep deprivation, apnea may directly drive down levels of these hormones, causing sexual dysfunction.
In the most recent study, published last month in The Journal of Sexual Medicine, scientists compared 80 women with obstructive sleep apnoea between the ages of 28 and 64 with 240 women without the condition. They found that the apnea patients had significantly higher rates of sexual dysfunction. Their findings echoed those of earlier studies on women and apnea.
In a study in 2009, researchers looked for signs of sexual problems in 401 men who showed up at a clinic for suspected sleep apnea. Of those who received the diagnosis, about 70 percent also had erectile dysfunction, compared with 34 percent in those without sleep apnea.
But on the bright side, treatment can make a difference. Patients who undergo surgery to correct facial abnormalities that contribute to apnea see improvements in intimacy, and those who start using masks at night that administer continuous positive airway pressure also report benefits in their sexual relationships.
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.
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.”
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.
A stroll through the recently opened Snore Centre clinic at Johnson Hospital in Spalding, Lincs.
According to a new report by iData Research, the leading global authority in medical device market research, the European anesthesia, respiratory and sleep-management device market was valued at over $1.4 billion in 2011. By 2017, this market is expected to reach almost $2 billion, fueled by the rapidly growing telehealth/homecare therapeutic sleep-apnea and ventilator segments. Philips Respironics, ResMed and CareFusion are leading these markets, despite growing competition.
“Sleep disorders are becoming much more widely diagnosed in Europe, which is driving the demand for more advanced devices that can diagnose, treat and monitor in the home,” says Dr. Kamran Zamanian, CEO of iData. “Philips, ResMed and CareFusion are leaders in this space, however many other companies have released products in a bid to gain share in this lucrative market.”
The report states that the market for automatic positive airway-pressure (APAP) devices, which automatically detect apneic events, are expected to be the fastest-growing segment. The U.K. and France are leading in sales growth, however there is expected to be a dramatic increase in demand in Germany, Spain and Austria.
Additionally, the ventilator segment is expected to see strong growth fueled by increased sub-acute and homecare usage as well as new remote-monitoring ventilators. Philips narrowly leads this market with their non-invasive homecare ventilators, but faces strong competition from ResMed.