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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.
I am pleased to announce I have been awarded the Middle East Hospital magazine award for excellence in respiratory care, and making an outstanding contribution to healthcare in the Middle East. The Snoring Disorders Centre took a stand at the Arab Health exhibition in Dubai this year to raise awareness of the negative impact that OSA is having in the UAE and wider Middle East, and I met with healthcare professionals interested in treating this issue in the Arab region. I also be attended Saudi Medicare in Riyadh in April to spread the message further around the region.
Levels of obesity, hypertension and heart disease are rocketing in the wealthy Middle East, mainly due to the life-style out there. People are working long hours, eating rich calorie-laden food, driving everywhere and not exercising enough. I believe that the success I have had in Lincolnshire can be replicated in the Middle East by raising awareness of the condition, and forming long-term partnerships with local hospitals, doctors, and government departments.
With the low level of awareness of sleep apnoea in the Middle East it’s no surprise that road accident rates out in Dubai and the UAE are dreadful. In fact road traffic accidents are the second major cause of deaths in the UAE. There are 3500 fatalities per year from RTAs in Saudi Arabia alone, and OSA could well be a factor in many of them.
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.”
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.”
The Lincolnshire-based Snoring Disorders Centre has opened a new clinic at Johnson Hospital in Spalding to enable sufferers of sleep apnoea from the surrounding communities easy access to a high quality treatment service.
The Snoring Disorders Centre (or Snore Centre) is based at Pilgrim Hospital in Boston, and a high demand for the service has led founder and sleep specialist Michael Oko to set up the Spalding clinic:
“The East Midlands and East of England is currently under-served in this therapy area, and people were having to travel long distances for diagnosis and treatment in Boston. Now the people of South Lincolnshire and North Cambridgeshire have an easily accessible sleep service, and the clinic is also easier to reach for patients from further afield”, said Mr Oko.
Up to 4% of the adult population are thought to suffer from sleep apnoea, which is often undiagnosed. This condition prevents sufferers from getting a good night’s sleep and is linked to serious medical conditions such as diabetes and hypertension. Sufferers are usually permanently tired, resulting in a reduced quality of life and an greatly increased risk of being involved in a road traffic accident. In a recent survey by road safety charity Brake one in seven drivers were found to have sleep apnoea.
Mr Oko added, “If you suspect that you or a relative may have sleep apnoea I strongly advise going to see your GP, who can refer you to a sleep clinic for diagnosis. You can also take this simple test
to find out if you have a high probability of being a sufferer. Treatment is straightforward and effective, and achieving a good night’s sleep can transform the lives of sufferers and their partners.”
At the Snore Centre there is a strong emphasis on patient satisfaction, which is monitored via interactive touch screen technology. Mr Oko saw 383 patients from April 2010 to April 2011 and on average 96% of patients were very satisfied with the service they received.
The Snoring Disorders Centre won an East Midlands Health and Social Care Award in the Service Transformation category in 2008, and also an MEH award for Excellence in Respiratory Care in 2009.
The results of a new study of 1000 drivers by the road safety charity Brake and Cambridge Weight Plan shows that one in eight drivers have nodded off at the wheel. They also found that one in seven (13%) of drivers suffer from sleep apnoea.
Julie Townsend, Brake’s campaigns director, said: “Tiredness at the wheel kills. Driving a vehicle is a huge responsibility that must be taken seriously. That means stopping when we feel drowsy and certainly never starting a journey tired. It’s a matter of life and death. We still have widespread misunderstanding of how to prevent driver tiredness, and ignorance about factors like sleep apnoea, a condition that can be treated. These messages still need to get through to the public, which is why we are calling for renewed efforts from the Government to tackle this issue urgently.”
Professor Tony Leeds, Medical Director, Cambridge Weight Plan, said: “Driver tiredness can have devastating results, but it is avoidable if drivers follow road safety and medical advice. I urge drivers to manage their sleep needs: make sure you get sufficient rest each night, and stop and rest if you feel sleepy at the wheel. If you often feel tired, there might be an underlying medical problem, so you should seek appropriate professional advice. A common cause of tiredness is obstructive sleep apnoea, which is more common among commercial drivers, and is linked to greater risk of crashing. Sleep apnoea is linked to body mass index, so overweight drivers should be particularly alert to the possibility of suffering from this disorder, but aware that it is treatable.”
I have long been calling for companies to test their drivers for sleep apnoea as a matter of routine. The test is simple and effective, and treatment is free on the NHS so will cost companies nothing to resolve, and will saving lives. With the Corporate Manslaughter Act now in force companies can and will be held legally responsible for failing to protect their employees, so there is every reason for employers of commercial drivers to act on this now.
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.