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The BBC reports today on a study showing that elderly men who spend little time in deep sleep could be at risk of developing high blood pressure. A study on 784 patients, in the journal Hypertension, showed those getting the least deep sleep were at 83% greater risk than those getting the most. Researchers say they would expect a similar effect in women.

The British Heart Foundation said it was important for everyone to prioritise sleep. High blood pressure – also known as hypertension – increases the risk of heart attack, stroke and other health problems. Researchers measured the “sleep quality” of 784 men over the age of 65 between 2007 and 2009. At the start none had hypertension, while 243 had the condition by the end of the study. The patients were split into groups based on the percentage of time asleep spent in deep, or slow wave, sleep. Those in the lowest group – 4% deep sleep – had a 1.83-fold increased risk of hypertension compared with those in the highest group, who spent 17% of the night in deep sleep.

One of the report’s authors, Professor Susan Redline from Harvard Medical School, said: “Our study shows for the first time that poor quality sleep, reflected by reduced slow wave sleep, puts individuals at significantly increased risk of developing high blood pressure. Although women were not included in this study, it’s quite likely that those who have lower levels of slow wave sleep for any number of reasons may also have an increased risk of developing high blood pressure.”

The report said further studies were needed to determine if improving sleep could reduce the risk. Natasha Stewart, senior cardiac nurse at the British Heart Foundation, said: “Whilst this study does suggest a link between lack of sleep and the development of high blood pressure, it only looked at men aged over 65.

“We would need to see more research in other age groups and involving women to confirm this particular association. However, we do know more generally that sleep is essential for staying healthy. It’s important we all try to make sleep a priority and get our six to eight hours of shut-eye a night.”

Obstructive sleep apnoea may cause changes in blood vessel function that reduces blood supply to the heart in people who are otherwise healthy, according to a study published in Hypertension: Journal of the American Heart Association.

However, treatment with 26 weeks of continuous positive airway pressure (CPAP) improved study participants’ blood supply and function.

“The findings should change how doctors treat patients with obstructive sleep apnoea,” said lead author Gregory Y.H. Lip, MD, Cardiovascular Medicine, University of Birmingham, United Kingdom. “Even apparently healthy patients with sleep apnoea show abnormalities of small and large blood vessels, as well as impaired blood supply to the heart muscle, and these can improve with CPAP therapy.”

The study is the first to show blood vessel abnormalities in patients with sleep apnoea. Previous studies have linked blood vessel dysfunction to cardiovascular disorders.

Reversing blood vessel abnormalities could help patients with obstructive sleep apnoea who are otherwise healthy avoid developing and dying from cardiovascular disorders, researchers said.

For the study, Dr. Lip and colleagues looked for changes in blood vessel function in 108 participants who were otherwise healthy, with no differences in age, sex, body mass index, and smoking status.

Of the patients, 36 people had moderate or severe obstructive sleep apnoea without high blood pressure, 36 had high blood pressure without obstructive sleep apnoea, and 36 individuals without high blood pressure or obstructive sleep apnoea.

Two studies that link the quality of sleep to the occurrence of erectile dysfunction and other urologic conditions were presented to reporters during the 2011 Annual Meeting of the American Urological Association (AUA).

The studies suggest that men with erectile dysfunction (ED) should be screened for obstructive sleep apnoea (OSA). After adjusting for age and other health conditions, patients with ED were more than twice as likely to have sleep apnoea than their normal counterparts.

This was the largest study to date to demonstrate a relationship between obstructive sleep apnoea and erectile dysfunction. Researchers at Mount Sinai Medical Center in New York evaluated 870 consecutively enrolled men through a cardiac screening program. Patients were screened for obstructive sleep apnea and erectile dysfunction through clinical questionnaires and were asked about their history of cardiovascular disease, blood pressure, diabetes and smoking. The mean age in the study population was 47.3 years, with a mean BMI of 30.2.

Sixty-three percent of patients in the study screened positive for obstructive sleep apnea, 5.6 percent had a history of diabetes, and 29 percent had a smoking history. The likelihood for having OSA increased as the severity of ED increased.

The good news for patients with both OSA and ED is that treatment for sleep apnea through continuous positive airway pressure therapy (CPAP), together with drug therapy, has been shown to improve symptoms of ED.

Researchers at Thomas Jefferson University Hospital, Philadelphia, USA, have conducted a study into use of the STOP-BANG questionnaire for detecting sleep apnoea in patients about to undergo surgery.

The study, titled, “Obstructive sleep apnea syndrome and postoperative complications: clinical use of the STOP-BANG questionnaire”, assessed the usefulness of the questionnaire to anesthetists in determining whether high risk scores on preoperative STOP-BANG (which is an acronym for: Snoring, Tiredness during daytime, Observed apnea, high blood Pressure, Body mass index, Age, Neck circumference, Gender) questionnaires during preoperative evaluation correlated with a higher rate of complications of obstructive sleep apnea syndrome (OSAS).

The study of 135 patients (of whom 56 had high risk OSAS scores) concluded that, “The STOP-BANG questionnaire is useful for preoperative identification of patients at higher than normal risk for surgical complications, probably because it identifies patients with occult OSAS.” They found that high risk OSAS patients had a 19.6% chance of complications, compared with only 1.3% of the low risk group.

In my view this is big issue for both sleep apnoea sufferers and anesthetists. If the anesthetist is aware that a patient about to go in for elective surgery (such as a hip op) has a high chance of OSA then they can be prepared for problems, such as difficulty inserting a breathing tube due to a blocked airway. I would advise all people going for elective surgery to take this simple questionnaire themselves, and then tell the anesthetist if they get a high risk score of 3 or more. Also, the Epworth Test can give a good indication of OSA.

STOP-BANG questionnaire

1.     Snoring- Do you snore loudly (louder than talking or loud enough to be heard through closed doors)?

Yes          No

2.     Tired- Do you often feel tired, fatigued or sleepy during daytime?

Yes          No

3.     Observed- Has anyone observe you stopping breathing during your sleep?

Yes          No

4.     Blood pressure- Do you have or are you being treated for high blood pressure?

Yes          No

5.     BMI – BMI more than 35kg/m2?

Yes          No

6.     Age – age over 50 years old?

Yes          No

7.     neck cimrcumferce- neck circumference greater than 40?

Yes          No

8. gender– gender-male?

Yes          No

—————————————————-

High risk of OSA –’ yes’ to three or more items

Low risk of OSA – ‘yes’ to less than three items

I found a very useful article entitled “The Relationship Between Fibromyalgia & Sleep Apnea, and How to Live With Both” by Adrienne Dellwo on About.com Guide.

Here is an extract:

Fibromyalgia and abnormal sleep breathing commonly go together. Sleep apnea is considered a possible cause or contributing factor for FMS, and FMS may increase your risk of sleep apnea.

Any sleep disorder can make FMS symptoms worse, so treating sleep disorders is often a big help in managing FMS. Sleep apnea is one of the more serious sleep disorders because it can lead to life-threatening conditions.
What is Sleep Apnea?

So far, we don’t know why fibromyalgia and sleep apnea go together. It’s possible that apnea-caused sleep deprivation contributes to the development of FMS. It’s also possible that lax connective tissues associated with FMS may make airway obstructions more likely.

Some symptoms of fibromyalgia and sleep apnea are similar, which can make it harder for you to detect and for your doctor to diagnose. Shared symptoms include:

* Unrefreshing sleep & excessive daytime sleepiness
* Difficulty concentrating
* Personality changes
* Depression
* Insomnia

Sleep apnea symptoms that aren’t associated with FMS include:

* Episodes of obstructed breathing during sleep
* Loud snoring
* Dry mouth upon waking
* Snorting, gasping or choking that wakes you up
* High blood pressure

If you have FMS and notice these symptoms, you should talk to your doctor about the possibility of sleep apnea.

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Snore Centre website

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