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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 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.
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.
Johnson Hsopital, Spalding
Here is July’s eNewsletter which I forgot to post on here last month. Contains some great images of the new Snore Centre clinic in Spalding.
Interactive patient satisfaction monitoring system at Snore Centre clinics
Asking your friends and neighbors to recommend a good hospital is the best way to find high-quality care, according to a study from Duke University’s Fuqua School of Business.
The researchers compared patient satisfaction surveys and clinical performance measures, such as administering standardized tests, from two large federal databases. Focusing on three common ailments, heart attack, heart failure and pneumonia, the team measured 30-day readmission rates at roughly 2,500 hospitals. The readmission rate reflects the number of patients who are hospitalized again within 30 days of discharge.
The patient satisfaction scores were more closely linked with high-quality hospital care than clinical performance measures, the authors found.
“Patients can sense if a hospital is doing things right,” said co-author Richard Staelin, professor of business administration at Fuqua. “If you want to figure out if a hospital is providing high-quality care, asking patients if they were satisfied with their care is a better indicator than whether the staff competently performs a battery of tests.”
I use the Jayex QI Interactive system in my clinic to do just that, and strongly believe that patient opinion should be used to guide the future of the NHS. Access to detailed patient feedback can enable consultants like myself to transform services to specifically meet the needs of the patient. By continually monitoring patient feedback all year round in real-time, doctors can analyse performance on an ongoing basis, and share best practice across the NHS.
In the Daily Mail yesterday Jenny Hope reports on a new study published in the Journal of the American Medical Association that indicates a link between sleep apnoea and dementia. The study that found women who have breathing problems during sleep were up to 50 per cent more likely to develop cognitive impairment or dementia than women who sleep normally. The research involved only older women, but the mechanism is likely to be important in triggering similar problems in men.
Dr Kristine Yaffe and a team from the University of California, San Francisco, carried out a study involving almost 300 women with an average age of 82 years who did not have dementia. The women were given medical tests for breathing disorders during sleep, which measured the number of times their breathing was interrupted or briefly ceased while they were asleep, and levels of oxygen deprivation, or hypoxia, in the brain. One-third met the criteria for sleep-disordered breathing. After more than four years of follow-up, 36 per cent of the women developed mild cognitive impairment or dementia. Forty-seven women (45 per cent) with prevalent sleep-disordered breathing developed mild cognitive impairment or dementia compared with 31 per cent of those without sleep-disordered breathing – an increase of 50 per cent in the numbers affected.
Dr Yaffe said, “Given the high prevalence and significant morbidity associated with both sleep-disordered breathing and cognitive impairment in older populations, establishing whether a prospective association exists between sleep-disordered breathing and cognition is important. This is especially important because effective treatments for sleep-disordered breathing exist.
“Furthermore, the finding that hypoxia and not sleep fragmentation or duration seems to be associated with risk of mild cognitive impairment or dementia provides clues to the mechanisms through which sleep-disordered breathing might promote cognitive impairment. The increased risk for cognitive impairment associated with sleep-disordered breathing opens a new avenue for additional research on the risk for development of mild cognitive impairment or dementia and exploration of preventive strategies that target sleep quality including sleep-disordered breathing.”
