Sleep Apnea

SLEEP APNEA (or APNOEA)
OBSTRUCTIVE SLEEP APNEA (OSA)
OBSTRUCTIVE SLEEP APNEA/HYPOPNOEA (shallow, slow breathing) SYNDROME (OSAHS)

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Obstructive Sleep Apnea (OSA) is a serious clinical condition in which there is intermittent and repeated upper airway collapse during sleep.? It results in either complete apnea, a ten second pause in breathing activity, or partial apnea, a period in which ventilation is reduced by at least 50%.

Sufferers choke and cease breathing due to obstruction in the throat, which occurs when the muscles controlling the tongue and soft palate relax and the airways narrow.? The brain reacts to this oxygen deficiency and alerts the body to wake up.? This arousal can happen hundreds of times every night.? Sufferers usually feel sleepy and lethargic the next day.

Definition
For definitions and clinical background visit www.sign.ac.uk/guidelines/fulltext/73/section2.html (The Scottish Intercollegiate Guidelines Network “SIGN”).

Apparently not all snorers have sleep apnea, and not all individuals who have sleep apnea snore.? Source: The British United Provident Association.? The American National Sleep Foundation estimates that sleep apnea is present in about 40% of those adults who snore.

Statistics
However the figures on the number of sufferers vary depending on the source.? We have seen figures of 0.3 – 2% of middle aged males (30-65 years old), and middle aged women as 0.5% to 1.0 percent.? In other places it is quoted as 5% of the population.? A study performed by Royal Prince Alfred Hospital in Sydney in 1995 indicated that it could effect as many as 10 percent of middle-aged men, and 5 percent of women – perhaps even more.

Sleep apnea causes adverse or worsens many health problems, including hypertension, cardiovascular disease, diabetes and cognitive impairment.

See Your Medical Practitioner
Sleep apnea is a serious condition, and it is recommended that you ask your General Practitioner (GP) for a referral to an appropriate sleep clinic for assessment.? Be aware that not all GPs know a specialist respiratory physician, and if you live regionally you may have to visit Sydney or Melbourne to receive the best advice.

The good news is, once you are in the right place, it is an easily diagnosed sleep problem.

If untreated, consequences vary from tiredness to premature death.? The sleeper stops breathing for up to two minutes until the body’s defence mechanism causes them to wake and breathe normally again.? In its mild form, OSA is characterised by snoring and results in disturbed sleep and daytime tiredness.? In more severe cases it can lead to obesity, hypertension, bladder problems and death from cardiovascular disease.

Overweight?
The John Hopkins study recommends weight loss to reduce OSA.? As little as 10 to 15 per cent weight loss can reduce or eliminate sleep-disordered breathing, and may curtail the cardiovascular risk associated with sleep-disordered breathing.

Obesity is apparently common in OSA, and the more overweight a person becomes appears to worsen the condition.

Accident Prone?
All people with reduced sleep increase their risk of accidents – and OSA sufferers are no exception.

We have seen figures supporting two to seven times more likely to have an accident – to 15 times more likely (in the case of a car accident).? It is an OH&S and insurance issue.

Link to Stroke and Heart Failure Patients
Studies have recently shown that between 50 and 80 per cent of stroke and heart failure patients have some form of sleep-disordered breathing.

Devices Used for Apnoea
Devices used include dental devices;? nasal clips;? differently configured pillows;? surgery and the Continuous Positive Air-Pressure (CPAP) mask.

Continuous Positive Air-Pressure Devices (CPAP)
Many people with Obstructive Sleep Apnea are prescribed a CPAP that pumps air into the lungs during the night.

It is important to persist with using the CPAP, although there is sometimes a reluctance to do so.? If you can access a video to encourage the use of the CPAP – please do.? Encourage your partner to see it too.

In addition, there have been studies that indicate that the mask may reduce high blood pressure.

OSA a risk factor in Liver Disease?
A study in the June 2005 issue of Hepatology looked at the connection between OSA and liver disease, independent of obesity.? Overall 20% had elevated liver enzymes, independent of body mass index (BMI).? The study concluded that severe OSA is a risk factor for elevated liver enzymes and further studies are needed to determine whether hypoxia (the deficiency of oxygen reaching the body tissues) contributes direct to liver injury.
Source American? National Sleep Foundation website, June 2, 2005.

For further information visit http://www.patient.co.uk/showdoc/40001277/

SUGGESTION:
Before visiting your GP, search the internet for the closest sleep clinic that suits you (just in case your GP needs the information).? Phone them to get further details, including the names of the specialists etc.? You may need the information when you go to your GP.

In Sydney there are sleep clinics at St. Vincent’s Hospital, Royal Prince Alfred Hospital and Royal North Shore Hospital to name a few.

Sleep psychologists are not common, and very in demand.? Research may be required to locate the right one for you.