Implications of sleep apnoea

The understanding of the possible effects of sleep apnoea on heart disease, diabetes, obesity, high blood pressure/hypertension, traffic accidents and other conditions is steadily growing. See below a number of studies and relevant links.

Sleep Apnea and Cardiovascular Disease.

An American Heart Association/American College of Cardiology Foundation Scientific Statement From the American Heart Association Council for High Blood Pressure Research Professional Education Committee, Council on Clinical Cardiology, Stroke Council, and Council on Cardiovascular Nursing Council.

Obesity Hypoventilation Syndrome

Specific metabolic and cardiovascular associated co-morbidities.

See the slides from symposium conducted by Jean-Louis Pépin, Jean-Christian Borel, Renaud Tamisier and Patrick Lévy.

Screening for Obstructive Sleep Apnea During Commercial Drivers

Philip D. Parks, MD, MPH, MOccH; Gerardo Durand, MD; Antonios J. Tsismenakis, MA; Antonio Vela-Bueno, MD; Stefanos N. Kales, MD, MPH.
OSA is common among commercial drivers and associated with a 2-to 7-fold increased risk of vehicular accidents. Commercial drivers with undiagnosed or untreated OSA pose significant public safety risks and economic costs. The goal of this study was to “field test” consensus screening guidelines for identifying such drivers during actual CDMEs.

An effective treatment

Here you’ll find further studies showing evidence supporting the use of CPAP as well as the influencers on adherence.

The current treatment of choice for sleep apnoea is Continuous Positive Airway Pressure (CPAP)
Ventilation. Since its proposal by Sullivan et al in 1981 (1), extensive studies have confirmed the efficacy of this treatment. Although in some patients surgery or weight loss may be a treatment option to achieve resolution, sleep apnoea is generally considered to be a lifelong condition, which has been suggested to be associated with an increased likelihood of cardiovascular disease, daytime tiredness, road traffic accidents and a reduced quality of life. It is thus imperative that good treatment take-up rates and subsequent compliance is achieved. In addition, the majority of data suggests that having additional support and troubleshooting at the beginning of CPAP treatment, as well as providing education and reinforcing the benefits of CPAP therapy to both the patient and their bed partner, enhances CPAP adherence.
Some studies can provide strong evidence of the effectiveness of CPAP treatment in improving symptoms and perceived health status in moderate to severe OSAHS (2).

A long-term interventional study with 100 patients being followed over nine months was conducted by Damjanovic et al (3). The study aimed to test whether an intensive support of OSAHS patients during the first 6 months of CPAP therapy can enhance CPAP adherence and improve clinical outcomes compared to standard support. In addition, the effectiveness and compliance of auto (APAP) and fixed pressure therapy was compared.

(1) Sullivan CE, Issa FG, Berthon-Jones M, Eves L: Reversal of obstructive sleep apnea by continuous positive airway pressure applied through the nares. Lancet 1981; 1: 862–865.

(2) Montserrat JM, Ferrer M, Hernandez L, Farré R, Vilagut G, Navajas D, Badia JR, Carrasco E, De Pablo J, Ballester E. Institut Clínic de Pneumologia i Cirurgia Toràcica and Servei de Psiquiatria, Hospital Clínic, Barcelona, Spain. Effectiveness of CPAP treatment in daytime function in sleep apnea syndrome: a randomized controlled study with an optimized placebo. Am J Respir Crit Care Med. 2001 Aug 15;164(4):608-13.

(3) Domagoj Damjanovic1, Andreas Fluck1, Hinrich Bremer, Joachim Müller-Quernheim, Marco Idzko and Stephan Sorichter. Department of Pneumology, University Hospital Freiburg, Germany. Compliance in Sleep Apnea Therapy: influence of home care support and pressure mode.