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Philips Respironics has released the first issue of Philips Respironics Clinical Newsletter, Philips Respironics – The Clinical Advantage.
The Clinical Advantage is designed to bring you up to date clinical information on a current topic of interest. Each issue will cover a specific theme and include an editorial by Dr David White, and externally written feature articles, case studies and reviews of ongoing research by leading physicians. Dr White writes:
“Welcome to the first edition of Philips Respironics’ newsletter The Clinical Advanage. This is a newsletter dedicated to keeping you up to date with clinical information and new clinical literature regarding sleep apnea. Obstructive sleep apnea (OSA) has been the engine that has driven the remarkable growth of the sleep field over the last 25 years. Although the medical community and the general public have been interested in the performance and quality-of-life problems that result from sleep apnea, the real concern has been the potential relationship between OSA and the cardiovascular system.
“The theme of the first issue is SDB and Cardiovascular disease and includes a feature article by Dr Michael Arzt (Germany). Michael Arzt summarizes the current state of the literature regarding the association between OSA and cardiovascular disease and points out many of the areas where controversy still remains. Case studies are also presented which develop several of these themes further. However, this controversy will not end until adequately powered, randomized, controlled, clinical trials are conducted addressing this issue. At last, several such studies are underway.”
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.
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.
1. Snoring- Do you snore loudly (louder than talking or loud enough to be heard through closed doors)?
2. Tired- Do you often feel tired, fatigued or sleepy during daytime?
3. Observed- Has anyone observe you stopping breathing during your sleep?
4. Blood pressure- Do you have or are you being treated for high blood pressure?
5. BMI – BMI more than 35kg/m2?
6. Age – age over 50 years old?
7. neck cimrcumferce- neck circumference greater than 40?
8. gender– gender-male?
High risk of OSA –’ yes’ to three or more items
Low risk of OSA – ‘yes’ to less than three items
The fourth annual World Sleep Day held on 18 March – ‘Sleep Well, Grow Healthy’ – was themed to highlight the importance of sleep for people of all ages. Newborn infants, children, adolescents and adults, both young and old, need quality sleep to maintain a healthy life.
The scale of the problem was highlighted by the recently published Philips Index for Health and Well-being report – a massive consumer research study conducted across 23 countries, including the United Arab Emirates and Kingdom of Saudi Arabia, involving more than 31,000 people, revealed that 35 percent of people do not feel they get enough sleep, impacting on both their physical and mental health.
Interestingly, with almost half of those responding citing ‘poor sleeper in general’ as a reason for sleep deprivation – it suggests that many may have just resigned themselves to not ever getting a good night’s sleep.
In reality, there are a number of potential causes for a disturbed night’s sleep. These include sleep disorders such as Obstructive Sleep Apnoea (OSA), which affects approximately 4 percent of the adult population. It’s a disorder characterized by airway collapse (behind the tongue) during sleep, which obstructs breathing. If untreated, it can contribute to the development of high blood pressure, diabetes, heart attacks, and strokes. Snoring should also not be ignored in children, as it may be a symptom of OSA.
To find out more about World Sleep Day 2011, visit www.worldsleepday.org.
(source: extract from a Philips press release)
In the latest edition of Sleep journal there is a study carried out at the University of Calgary entitled “HEALTH CARE UTILIZATION IN OSA PATIENTS WITH EDS”
The study concludes that:
“Excessive daytime sleepiness (EDS) is associated with increased health care utilization among patients referred for assessment of Obstructive Sleep Apnoea (OSA). Further investigation is required to determine whether the findings are related to direct effects of sleepiness, or in part, to interactions with other comorbidity such as OSA.”
This study, which surveyed over 2000 adults during two years, serves as further evidence that OSA is strongly linked to other medical conditions, such as diabetes, hypertension, and depression. With the obesity epidemic which is spreading across the world, and in particular in developed and wealthy countries, the impact on society of this chronic condition is becoming ever more apparent.
Having seen the positive impact that treating OSA has had on the lives of patients at my clinic in Lincolnshire, I believe that it is in everyone’s interest that treatment becomes more widely available and affordable. Any new evidence that will make health authorities sit up and take notice is very welcome.