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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.”

Take the Snore Centre sleep apnoea test to see if you could be a sufferer

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 new study published in the British Medical Journal this month has shown that a very low energy diet can have long-term benefits for sleep apnoea sufferers.

It is already known that obstructive sleep apnoea is associated with several adverse outcomes, including impaired cognitive function, vehicle crashes and occupational injuries, and death.

Randomised controlled trials have recently shown that weight loss improves obstructive sleep apnoea in overweight and obese patients.   The long term effect of weight loss has been studied only in people with mild obstructive sleep apnoea and in older patients with type 2 diabetes.

“Of all people with obstructive sleep apnea, an estimated 60-70% are either overweight or obese,” writes Kari Johansson, PhD student in the Obesity Unit, Department of Medicine at the Karolinska Institute in Stockholm, Sweden, and colleagues. “Given the close association between obstructive sleep apnoea and obesity, weight loss has been advocated as a primary treatment option in obese patients with sleep apnoea…. Despite an improving case for the robust treatment effect of weight loss in obstructive sleep apnoea, concerns remain regarding the long term maintenance of improvements, especially after rapid weight loss with a very low energy diet.”

Study conclusions:

  • The initial improvements in apnoea-hypopnoea index after nine weeks of a very low energy diet (−58%) were largely maintained at the one year follow-up (−47%)

  • At one year, 48% (30/63) no longer required continuous positive airway pressure and 10% (six/63) had total remission of obstructive sleep apnoea

  • Patients who lost the most in weight or had severe sleep apnoea at baseline benefited most

This study on the relationship between obesity and OSA has just been published on Sleep Scholar by the Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic College of Medicine. Here is the abstract:

The belief that weight loss improves obstructive sleep apnea (OSA) has limited empirical support. The purpose of this 4-center study was to assess the effects of weight loss on OSA over a 1-year period.

Methods
The study included 264 participants with type 2 diabetes and a mean (SD) age of 61.2 (6.5) years, weight of 102.4 (18.3) kg, body mass index (BMI) (calculated as weight in kilograms divided by height in meters squared) of 36.7 (5.7), and an apnea-hypopnea index (AHI) of 23.2 (16.5) events per hour. The participants were randomly assigned to either a behavioral weight loss program developed specifically for obese patients with type 2 diabetes (intensive lifestyle intervention [ILI]) or 3 group sessions related to effective diabetes management (diabetes support and education [DSE]).
Results
The ILI participants lost more weight at 1 year than did DSE participants (10.8 kg vs 0.6 kg; P < .00l). Relative to the DSE group, the ILI intervention was associated with an adjusted (SE) decrease in AHI of 9.7 (2.0) events per hour (P < .001). At 1 year, more than 3 times as many participants in the ILI group than in the DSE group had total remission of their OSA, and the prevalence of severe OSA among ILI participants was half that of the DSE group. Initial AHI and weight loss were the strongest predictors of changes in AHI at 1 year (P<.01). Participants with a weight loss of 10 kg or more had the greatest reductions in AHI.
Conclusions
Physicians and their patients can expect that weight loss will result in significant and clinically relevant improvements in OSA among obese patients with type 2 diabetes.

The conclusions of a study in Nature Reviews Endocrinology 5, 253-261 (May 2009)

“Restorative sleep is essential for well-being, but sleep curtailment has become a common behavior in modern society. In addition, sleep disorders, particularly OSA, are very common in individuals with metabolic and endocrine disorders, but often remain undiagnosed. The accumulated evidence for a deleterious effect of short-duration or poor-quality sleep on metabolic and endocrine function supports the hypothesis that chronic, voluntary sleep curtailment and sleep disorders such as OSA may adversely affect the course of disease in patients with metabolic and endocrine disorders. Treatment of OSA by CPAP has the potential to improve glucose metabolism and appetite regulation. Screening for habitual sleep patterns and OSA—for which simple and inexpensive tools are available—such as sleep logs to characterize habitual sleep patterns and the Berlin Questionnaire, may be critically important in patients with endocrine and metabolic disorders.”

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.

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