For sufferers of sleep apnea, the impact of the condition on their life can be substantial. The condition results in frequent waking during the night with shortness of breath, severe tiredness during the day and disruption of sleep for their sleep partner.

Current medical guidelines indicate use of continuous positive airway pressure (CPAP), along with weight control and alcohol management. But more recently, the use of upper-airway surgery is becoming more popular as the initial treatment for obstructive sleep apnea (OSA), the most common type of apnea in countries such as Australia and Scandinavia.

Researchers from the University of Adelaide in Australia, led by Dr. Adam Elshaug, report in the British Medical Journal that surgery should not be the first treatment for OSA.

A review of 7 randomized trials found that surgery did not have any impact on symptoms in 5, and where there was quality of life improvements following surgery they rarely lasted beyond 12 to 24 months.

Also, Dr. Elshaug’s team reviewed 48 studies which showed that 62% of the 21,346 patients who had undergone surgery for obstructive sleep apnea suffered persistent, adverse effects, including difficulty swallowing, voice changes, smell and taste disturbances and dry throat.

Over 20% said that they regretted having the surgery in the first place.

According to the study’s authors: “Surgery for obstructive sleep apnoea should be done within controlled clinical trials, Patients should be informed about the trial, as well as the inconsistent results, the associated pain, the potential side effects and potential for relapse.”

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Researchers at the Mayo Clinic in Rochester, Minnesota have determined that people with obstructive sleep apnea, the most common form of sleep-disordered breathing (SDB), are far more likely to die suddenly in their sleep from heart related problems than the general population. They also found that this is the opposite of the general population who are more likely to die from heart-related problems, such as heart attack and cardiac arrest, during the day.

It is generally believed that the risk of sudden cardiac death is lower during sleep periods because of the reduction of stress factors that can trigger heart problems. Based on earlier studies, the likelihood of suddenly dying from cardiac arrest or heart attack is actually the highest between the hours of 6 a.m. and noon.

There are several different forms of SBD, however, this study focused only on people that have obstructive sleep apnea. Estimates range upwards of 25% of North Americans who suffer from obstructive sleep apnea.

The data utilized for this study came from the death certificates of 112 Minnesotans who were tested for sleep apnea and subsequently died suddenly from cardiac causes between July 1987 and July 1983. Of the people who died from cardiac causes between midnight and 6 a.m., 46% were diagnosed with obstructive sleep apnea while only 21% had other diagnoses. This is compared to 16% of the general population who die from cardiac causes during those hours.

The study was published in the New England Journal of Medicine.

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A recent study of 448 older women finds that those with sleep-disordered breathing (SDB), such as obstructive sleep apnea, had a higher incidence of cognitive decline.

The participants of the study, who averaged 83 years of age, underwent an overnight sleep study to determine if they had SDB. They were also given standard tests of memory, attention and other cognitive abilities.

The researchers found that those participants with SDB showed a higher likelihood of cognitive impairment than those without. Further, those with severe breathing problems had more than 3 times the increase in risk of mental impairment.

The link between SBD and mental impairment was predominantly strong in women who carried the gene linked to Alzheimer’s disease.

According to Dr. Adam P. Spira, a research fellow and the University of California San Francisco and lead investigator on the study, the findings do not prove that nighttime breathing problems directly contribute to cognitive decline. He did say, however, that it is “quite plausible”.

The current theory is that SDB results in chronic oxygen depravation with leads to damaged brain cells. Additionally, women who carry the Alzheimer’s gene may be more susceptible to this damage.

Dr. Spira adds that additional research needs to be conducted to determine whether SDB is a predictor of future cognitive decline.

The findings of this study were published in the Journal of the American Geriatrics Society.

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A new study by Vancouver Coastal Health Research Institute and the University of British Columbia finds that people with sleep apnea are at twice the risk of being in a car crash. The researchers also found that people with sleep apnea were 3 to 5 times more likely to be in a serious accident resulting in personal injury.

The researchers studied data from the Insurance Corporation of British Columbia on nearly 1,600 people, half of whom were diagnosed with sleep apnea.

“Car accidents are more common and more serious with people with sleep apnea,” Dr. John Fleetham, a UBC professor of medicine, said Wednesday. “If you fall asleep at the wheel, you are more likely to be at risk for a head-on collision. It’s not an act of God. It’s related to conditions that can be treated and prevented.”

The researchers stated in their report that the patients were not aware of the potential driving hazards caused by sleep apnea. Even those patients with fairly mild sleep apnea were at increased risk for serious crashes.

Statistics show that men have more accidents than women, but that for those with sleep apnea the accident rates are the same.
This study comes on the heels of a debate over the inclusion of sleep apnea among the conditions to be considered at the time of issuing a driver’s license.

The European Cooperation in the field of Scientific and Technical Research (COST) hosted a meeting last October on Action 26 with international experts to discuss the best ways to include obstructive sleep apnea among the disorders that create a serious risk for accidents. This initiative as also presented by COST to the High Commission on Transport.

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According to Drs. Daniel J. Schwartz and Gillian Karatinos of The Sleep Center at University Community Hospital in Tampa, Florida, people with obstructive sleep apnea are often depressed.

A study conducted by Drs. Schwartz and Karatinos, published in the Journal of Clinical Sleep Medicine, concludes that treatment with continuous positive airway pressure (CPAP) may improve the depression symptoms in patients with obstructive sleep apnea.

In a prior study of 50 obstructive sleep apnea patients, researchers found a significant improvement in depression symptoms after beginning home CPAP treatment. Follow up with these patients after 1 year found that the ongoing CPAP treatment resulted in continued improvement in the patient’s depression symptoms.

“The significance of our findings,” Dr. Schwartz said, “is that symptoms which might otherwise be ascribed to depression — feelings of sadness, discouragement about the future, feelings of excessive personal failures, perceived decreases in self-confidence, a sense of being overly self-critical, the inability to derive pleasure from things, and even suicidal (thoughts) — may at times be attributable to obstructive sleep apnea, an easily treatable medical illness.”

The report states that some patients that are being treated for depression with medications might experience better anti-depression results with CPAP treatment if their depression is due to obstructive sleep apnea.

Their report also says, however, that it is not completely understood how CPAP treatment improves the symptoms of depression.

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A new study conducted by Umea University Hospital in Sweden concludes that sleep apnea is a risk factor for early death in people that have had a stroke.

A research team, led by Dr. Karl A Franklin, studied the long term survival of 132 stroke patients that were admitted for in-patient hospital stroke rehabilitation between 1995 and 1997. All of the study’s subjects had sleep apnea studies performed approximately 3 weeks after their stroke and were followed for an average of and additional 10 years.

The researchers found that 88% of the study’s subjects died during the follow up period. This included 100% of those patients that had obstructive sleep apnea (breathing blocked by collapsing airway tissues) and 96% of those with central sleep apnea (interruption of respiration controlled by the brain). 81% of the patients that did not have a diagnosis of sleep apnea also died during the follow up period.

The mortality rates of obstructive sleep apnea patients were 76% higher than those without apnea.

Said Dr. Franklin: “Sleep apnea occurs frequently among patients with stroke, but it is still unknown whether a diagnosis of sleep apnea is an independent risk factor for mortality.”

The results of the study were published in the Archives of Internal Medicine.

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