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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.
The NHS Institute for Innovation and Improvement is publishing a profile of the Snoring Disorders Centre, outlining the service and the impact it has had both for individual patients and Lincolnshire as a whole. This will be put up on the NHS Innovations website and circulated throughout the NHS as an example of best practice in service innovation. Here is an extract on the benefits the service has had in road accident reduction:
“Occupational road related deaths and accidents in Lincolnshire average about 79 per year. 20% of car accidents are shown to be sleep related although it’s uncertain how many are due to obstructive sleep apnoea. The cost of each fatal accident is around £1.64 million, so every accident prevented is of significant benefit to society and to the NHS. Many of our patients admit to feeling drowsy at the wheel.
“By December 2010, the number of fatal road traffic accidents had fallen from 79 to 45. This represents a saving of over £55 million to the economy, including the NHS. A contributory factor may be that the service has treated over 1,200 patients with sleep apnoea and these people are now able to drive more safely, rather than being in fear of falling asleep at the wheel.
“One patient who drives 50,000 miles a year for work said using the CPAP machine to treat his sleep apnoea has turned his life around: ‘For four or five years I struggled to sleep and I used to need two naps every day just to get through the day. My GP referred me to Mr Oko when I said I had trouble sleeping. Within weeks he got me on a CPAP machine which I use every night and I’ve never looked back. It’s made a huge difference to my life’.”
Carole Upcraft has launched an e-petition calling for the government to pressure lorry drivers to have tests for sleep apnoea, which causes daytime sleepiness and fatigue.
Her son Daniel, 32, suffered brain damage and his fiancée Nicola Culshaw, 33, was killed when their car was hit by a lorry while queuing for the Dartford tunnel on the M25 in April last year. The lorry driver, 40-year-old David Thomas from Upminster, was initially charged with causing death by dangerous driving, but the case was dropped when it was discovered he had undiagnosed sleep apnoea.
Library supervisor Mrs Upcraft, of Knoll Rise, Orpington, said: “There is no point in being vengeful here. We just need to find a positive out of what happened. We do not want another family to go through what we have gone through. Research shows that 41 per cent of HGV drivers have a sleep disorder of one kind or another, but most of them won’t be aware of it.”
The petition reads:
Tired drivers cause violent deaths & horrific injuries
Responsible department: Department for Transport
I would like a debate to raise awareness for the early diagnosis of HGV drivers with sleep apnoea. Last year my son and his fiancee were crashed into by a driver who had undiagnosed sleep apnoea. My son was left with serious brain injuries and his fiancee was killed. The driver was charged with death by dangerous driving but days before the trial the case was dropped by the CPS as he was driving unaware of this medical condition. There are clear criteria and indicators as to who is likely to suffer this condition. Please help raise awareness with haulage employers and GP’s. So that no other person is killed by a condition that is treatable.
To sign the petition, which needs 100,000 signatures to be considered by the government, go to epetitions.direct.gov.uk/petitions/5851
The father of Toby Tweddell, who was killed in a road accident in 2006, has spoken out on radio 5 live calling for all lorry drivers to be screened for sleep apnoea. The driver responsible for the accident also joined the call for action.
This tragic case demonstrates the fatal consequences of the lack of awareness of the condition, both within the medical profession, and by drivers themselves. It also shows that commercial drivers have nothing to fear from a positive diagnosis as the driver in this case was absolved of resposibility for the accident having been misdiagnosed. He is still driving today having been treated successfully.
The coroner of the case, and Toby’s parents both called for screening at the time of the killing, and five years later nothing has been done and road deaths due to sleep apnoea have continued. However, with the Corporate Manslaughter Act now in full force a similar case could now result in the driver’s employers being sued for negligence. Hopefully companies will now take action before this happens again.
The BBC reported at the time, “Mr Tweddell, 25, from Sale, Greater Manchester, was killed when a lorry driver ploughed into a queue of traffic on the M62 in Merseyside in 2006. Lorry driver Colin Wrighton had been suffering obstructive sleep apnoea. The 54-year-old’s condition had yet to be diagnosed but he had complained to his doctor about feeling tired four months before the accident. Tests had been run for diabetes, which came back negative.
“Mr Wrighton was initially charged with causing death by dangerous driving, but the Crown Prosecution Service offered no evidence against him after his sleeping condition was revealed. In giving his narrative verdict, which was released as a statement, the coroner said: “It is my intention to prepare a Rule 43 Report to the Lord Chancellor concerning obstructive sleep apnoea in an endeavour to reduce the number of deaths that arise annually from this condition.”
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.
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.”
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
Hi, my name is Stuart I live a pretty normal life for a 27 year old, other than the fact that during a night’s sleep my wife was complaining of my very loud snoring. This argument rumbled on for ages, until she said “if you don’t go to the doctors to see if they can sort this we might have to break up”: this is how serious things got for us.
So as I thought I was fine I went to the doctors and apologised for wasting his time. He asked some questions so I told him about my wife’s threats then he asked how I felt, so I opened up and told him I feel just as tired when I get up as when I went to bed. I also had a very short temper and this was not me; as anyone who knows me will tell you I am very laid back. The doctor said straight away it is one of two things; either diabetes or sleep apnoea. So he decided to rule out diabetes first -which he did with a blood test- then referred me to a sleep apnoea clinic.
I was very apprehensive and not sure what to expect. I turned up thirty minutes early with my wife (it’s a standing joke that I do not like being late) to book in and be shown to the waiting room. I knew I was in the right room as there were four men in there fast asleep, and one lady reading a book. As my wife was chatting with the lady she found out she was a wife of one of the men. I sat down and waited, trying to make sure I did not fall asleep, but sleep apnoea took its toll. I awoke with my wife tapping me on the arm saying the nurse wants to do some checks on my blood pressure, weight, height and measurements, than back to the waiting room and more sleep.
I was shown through to Mr Oko and I was asked to fill in a very small questionnaire on sleep and how I felt. While doing this Mr Oko was asking my wife questions like “does he stop breathing”, and my wife said no he goes quiet, but I know he is alive as his chest goes up and down. (YOU MUST TAKE YOUR BED PARTNER TO YOUR FIRST APPOINTMENT AS I DID NOT KNOW HALF OF THE ANSWERS THAT MY WIFE GAVE MR OKO)
I think I scored 18 on the questionnaire, which I was then told was high, and there was a good chance I had sleep apnoea. Mr Oko asked if I would be prepared to come in and collect a sleep analysis machine to find out what was going on.
I turned up to my second appointment to collect the sleep analyser; needless to say while waiting for my appointment I had a little sleep, as when I have a comfy chair and nothing to do I fall asleep at the drop of a hat. Mr Oko explained how to put on the machine and then took it off telling me to put it on before I go to bed and take it off the next morning (TIP NO1. MAKE SURE YOU TURN OFF THE SLEEP ANALYSER AS SOON AS YOU WAKE UP)
Two weeks later I returned to Mr Oko. When I was called in I was shown on a computer the results. Mr Oko showed me where I was snoring and was concerned at how low my oxygen levels were dropping, and explained that was enough evidence to prescribe me a C Pap machine. Mr Oko then measured my nose and gave me a mask ( TIP NO2. THESE MASK ARE DAUNTING WHEN YOU FIRST SEE THEM SO START OFF WHILE SITTING WATCHING THE TELEVISION, JUST PUTTING ON FOR A FEW MINUETS AT FIRST YOUR PARTNER WILL POSSIBLY JUST LAUGH, BUT YOU WILL BOTH GET USED TO IT).
For the next stage I was called by a Respironics sleep support team, letting me know they would be delivering my C Pap machine and pipes. I got home and plugged it in. Again, I was very apprehensive about going to sleep. When I went to bed I put the mask on and started the machine the first time felt very strange with air blowing up my nose, but soon felt ok (I remembered the words of mr Oko: if you manage a couple of hours then when you wake up you will feel FULL OF BEANS). I think I managed about four hours before taking it off, but a lot of people I know say the normal is about two hours building up to a full night’s sleep. I am not sure if tip 2 helped, but on night two I managed a full night and when I woke up the next morning sure enough I felt FULL OF BEANS.
I was amazed at how quickly I felt the benefit; this is when the thought of that dreadful mask goes away and it becomes the best thing since sliced bread.
My Wife is happy as the snoring has stopped and we both sleep much better. My short temper has gone and I am back to my normal self. My thanks goes to my wife for the constant nagging and to the doctor for getting me diagnosed very quickly, and to Mr Oko for all the help and support I could have ever wanted.
If you feel you or your partner could be suffering from sleep apnoea then please go and get yourself checked. Remember, sleep deprivation is a form of torture; don’t torture yourself or your sleep partner. I will guarantee you will feel the benefit straight away. You will feel full of beans again: don’t delay get checked ASAP.
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