New Guidelines for treating Obstructive Sleep Apnoea (OSA)

If you already suffer from sleep apnoea, or think that you or your partner may have this dangerous problem, and it remains undiagnosed for whatever reason, then the new rules that have been issued in the United States will have some real meaning for you.

The American College of Physicians (ACP) has published new clinical practice guidelines regarding the management and treatment of OSA in adults. It deals with the known detrimental effects of the problem, and discusses the limitations of the various available treatments. These findings endorse those of the AASM – the American Academy of Sleep Medicine but take recommendations further.

As ever, the USA is ahead of the UK in dealing with this huge problem, partly because it is so much more widespread in the community there. Much of this can be linked to obesity, a major problem in the USA, and which is rapidly becoming so here due to changes in our diet, lower exercise levels in youth, and sedentary occupations now being the largest group by far versus manual workers. Alcohol also often plays a significant role in the equation – mostly due to the high calorific intake and the effect that alcohol can have on sleep hygiene.

What is OSA?

OSA disrupts breathing during sleep, and this is usually as a result of the muscles and soft tissues in the throat relaxing and collapsing to block the airway. It can last for about 10 seconds or even more. It affects people of all ages, but particularly those of us in middle age, and particularly the elderly.

However, we believe that around 80% of cases remain undiagnosed. OSA is easy to treat but when left undiagnosed and untreated, is linked with a range of serious health concerns that include heart disease and stroke, diabetes and high blood pressure, called hypertension. Fatigue becomes a huge problem too.

Current approved treatments for OSA and sleep disordered breathing

OSA is a chronic medical disorder that requires immediate action, but also requires long term, and often lifelong. therapy. Obviously a healthier lifestyle will come high on the list from any GP but this will not stop the problem of your snoring immediately, and sometimes does not succeed at all.

As well as recommending weight loss in overweight and obese patients, it recommends and approves the following treatments as it is recognised that weight-loss intervention alone will not achieve the desired objectives.

Medical Treatments and Clinical Recommendations for OSA

CPAP Mask wearer

  • Continuous Positive Airway Pressure (CPAP) is recommended for more serious sufferers but it is readily identified that many patients reject this treatment for various reasons, particularly having to wear a mask for such long periods of time, claustrophobia, having a dry mouth, or the associated discomfort of the mask amongst others.
  • It is still however strongly recommended for chronic sufferers if acceptable.

Sweet dreams

  • Mandibular Advancement Devices (MAD’s or Splints) are fully recommended as a primary treatment route and a strong option in many cases versus CPAP. They are more readily accepted than masks and have many distinct advantages over them including, ease of wear, instant results, high rates of effectiveness and also being inexpensive by comparison – even bespoke mouthpieces or the now available self-fit versions which are highly adjustable compared to the standard oral appliance – although this may be the best starting point.
  • Strongly recommended by ACP for less severe versions of OSA.

Snoring Surgery

  • Surgery however is not listed in the ACP’s summarized recommendations, but the guideline does specifically discuss its role as a treatment for OSA. It highlights that surgical procedures, which are intended for sleep-disordered breathing, are not as effective as either CPAP or using MAD’s. Currently success rates vary greatly and can be as low as 20%, as well as it sometimes requiring several procedures.
  • Not currently recommended by ACP to American Physicians.

More and more clinics, doctors and hospitals in the USA now recommend using oral appliance technology in the form of a mouthpiece to be used when sleeping and this is now becoming more accepted as a route here in the UK, particularly now that higher quality MAD’s are NHS Approved.

By John Redfern

 

 

 

 

 

 

 

 

 

 

 


Snoring mothers-to-be are linked to low birth weight babies

The British Press have covered this subject extensively this week based on the results of a new research study that has just been completed in the United States. The research was published in the journal ‘Sleep’.

Snoring can be more than just an annoyance to others who are trying to sleep in the same room. For pregnant women, snoring could indicate certain higher risks. Experts say that snoring may be a sign of breathing problems that could deprive an unborn baby of oxygen.

Snoring is often a key sign of obstructive sleep apnoea, which results in the airway becoming partially blocked, said the researchers, whose findings appear in the journal Sleep. This can reduce blood oxygen levels during the night and is associated with serious health problems, including high blood pressure and heart attacks. The experts stress sleep apnoea can of course be easily treated.

The study found that chronic snorers, who snored both before and during pregnancy, were two thirds more likely to have a baby whose weight was in the bottom 10%.

Newborn baby girl sleeping

They were also more than twice as likely to need an elective Caesarean delivery, or C-section, compared with non-snorers.

Dr Louise O’Brien, from the University of Michigan’s Sleep Disorders Centre, said: “There has been great interest in the implications of snoring during pregnancy and how it affects maternal health but there is little data on how it may impact the health of the baby.

“We’ve found that chronic snoring is associated with both smaller babies and C-sections, even after we accounted for other risk factors. This suggests that we have a window of opportunity to screen pregnant women for breathing problems during sleep that may put them at risk of poor delivery outcomes.”

Previous research has already shown that women who start to snore during pregnancy are at risk from high blood pressure and the potentially dangerous pregnancy condition pre-eclampsia.

More than a third of the 1,673 pregnant women recruited for the new US study reported habitual snoring. They were also more than twice as likely to need an elective Caesarean delivery, or C-section, compared with non-snorers.

Scientists found that women who snored in their sleep three or more nights per week had a higher risk of poor delivery outcomes, including smaller babies and Caesarean births.

The very worst cases of sleep apnoea can be treated with CPAP (continuous positive airway pressure), which involves wearing a mask attached to a machine during sleep, which pumps oxygen to keep the airways open. Most other forms of sleep apnoea can be treated with the wearing of a simple snoring mouthpiece, similar to a gumshield that is worn for sports.

Dr O’Brien added: “If we can identify risks during pregnancy that can be treated, such as obstructive sleep apnoea, we can reduce the incidence of small babies, C-sections and possibly NICU (neo-natal intensive care unit) admission that not only improve long-term health benefits for the newly born but also help keep costs down.”

By John Redfern


Sleep disorders vary regionally – and so does support and diagnosis

Recent research carried out by the British Lung Foundation, in conjunction with both Guys and St Thomas’ Hospital in London, has highlighted that the provision of services to diagnose obstructive sleep apnoea, or OSA, varies a great deal across the UK, and it doesn’t match the worst areas for the problem.

OSA is linked to serious ill health, and the figures for the problem have continued to rise steeply across the last few years. This is partly due to the higher numbers of the population reaching middle age, at which time OSA becomes much more prevalent, and also because of certain lifestyle factors. Increased weight is a major contributory factor in the problem, due to our vastly changed pattern of eating and drinking across the last decade.

The population’s average age and girth has increased, both of which are risk factors for obstructive sleep apnoea. These increases are forecast to continue.

Sleep Apnoea infographic

Disturbed unsatisfactory sleep

OSA is a condition that disrupts breathing during sleep, usually as a result of the muscles and soft tissues in the throat relaxing and collapsing to block the airway. This usually lasts for 10 or more seconds. It affects people of all ages, including up to 4% of middle-aged men, 2% of middle-aged women and 20% of those aged over 70. However, it is estimated that around 80% of cases remain undiagnosed. In real terms we estimate about four million people in the UK to be sufferers.

Although it’s relatively easy to treat OSA, when it is left undiagnosed and untreated, it has been closely linked with a range of serious health concerns including stroke, heart disease, depression, diabetes, and high blood pressure. More recently, Alzheimer’s disease, glaucoma, and certain forms of cancer have also been related to it. OSA can also significantly affect one’s quality of life and ability to work, as well as increasing the chances of road accidents due to fatigue.

Regional differences

Wales, large parts of East Anglia, East Yorkshire, Lincolnshire and the North-East were found to be areas with the highest predicted rates of OSA. Larger urban areas in England and Scotland and the counties to the west of London were amongst the areas with the lowest predicted prevalence.

This pattern contrasted considerably with the availability of local sleep services for diagnosing and treating the condition, with large urban areas being better served despite the lower risk of OSA, and parts of mid-Wales, the North-West and East Anglia having much lower numbers of identified sleep centres, of which there are 289 in total, each one being required to serve an average of 1.25 million people.

Diagnosis of OSA

Professor Adrian Williams, Medical Advisor at the British Lung Foundation, Professor of Sleep Medicine at Guys and St Thomas’ Hospital, and co-author of the study says in a press statement: “Too often, a lack of awareness leads to the symptoms of OSA being not recognised or dismissed simply as an irritation for anyone who shares a room with someone affected. However, OSA can have a severe impact on quality of life and is associated with a range of serious health problems including heart disease, stroke, diabetes and depression.

“In most cases, OSA is easily treatable in a way that can successfully minimise the associated risks.

Self-diagnosis is therefore often a key requirement for OSA, and fortunately, by using easily accessible NHS approved products, such as an oral appliance, or mouthpiece which keeps open the airway whilst sleeping, the majority of serious cases can be prevented and better health attained.

By John Redfern


Snoring can trigger a stroke or heart attack

Whilst waiting to go into a meeting the other day I happened to pick up a copy of a daily newspaper in the waiting area, and came across an interesting comment in the column written by the well-known agony aunt Miriam Stoppard.

It should be said that as well as having performed that role, and also that of TV presenter, she is a fully qualified Doctor, having worked in several major hospitals including that in her home town, Newcastle, before going on to become the managing director of a large pharmaceutical company. She has also written several books on health including The Children’s Medical Handbook.

Here’s what she wrote:

One of my sons snored so loudly that the whole house seemed to vibrate. It was the vibrations that worried me, not the noise.
Then I read some research showing that road workers who habitually used a pneumatic drill can get disease of the arteries in their arms due to the vibrations from the drill. It’s called Raynaud’s disease and is the result of furring up your blood vessels. In cold weather, your hands get cold and painful very quickly – so-called dead hands”.

White Finger from chain saw

Coming from an area where using this type of equipment was common, I was familiar with it, but knew it locally as ‘Vibration White Finger Disease’ – which aptly describes the look of the sufferer’s hands. It was quite common amongst Forestry workers. Medical research has proved that this arterial disease is due to the regular vibrations from industrial drills or saws.

It transpires that the vibrations due to snoring can have a similar effect to this.

Snoring can trigger stroke and heart trouble – and this is because habitual snorers are more likely to develop furred up carotid arteries – the main arteries in the neck that supply oxygenated blood to most of the brain.

Further research shows the trauma caused by the vibrations of snoring may result in inflammation leading to arteries thickening, and cutting down the blood flow.

Snoring is commonly linked to hardening of the arteries around the heart, which can lead to heart attacks. It is thought that this may be due to sleep apnoea that can cause the inflammation and contribute to furred up arteries.

We assess that three million Britons have sleep apnoea, where the tissue of the throat muscles collapses, triggering snoring and, in some cases, stopping the flow of air altogether, leading to you briefly waking up, but the majority of cases go undiagnosed – mostly because snoring is still ignored – and simple treatment such as an anti-snoring mouthpiece is so easily available. These oral appliances are worn at night, preventing your snoring immediately. They are highly effective, are non-prescription and some are also NHS Approved.

They can save lives – maybe yours. 

By John Redfern