Sleep-Apnea-Treatment-Reduces-Accidents

Monday, December 11, 2006
NEW YORK (Reuters Health)
The results of a preliminary study suggest that memory deficits that are common among people with
sleep apnea can improve when they are treated with positive airway pressure.
Sleep apnea occurs when breathing passages become obstructed during sleep, often when soft
tissues around the larynx and throat collapse inward. Breathing can be interrupted temporarily but
frequently, often accompanied by snoring. A proven treatment is a face or nose mask connected to
a machine that delivers continuous pressurized air to keep the airways open during sleep.
Dr. Molly E. Zimmerman at Albert Einstein College of Medicine in Bronx, New York, and her
associates screened 179 people diagnosed with sleep apnea, and identified 58 with measurable
memory impairments.
All 58 subjects were prescribed treatment with a positive airway pressure (PAP) device, with an
internal microprocessor to monitor compliance. The results are reported in the December issue of
the medical journal Chest.
After 3 months of treatment, the investigators classified subjects according to treatment adherence:
14 used positive airway pressure on average of less than 2 hours per night (poor users); 25 who
used PAP 2 to 6 hours per night (moderate users); and 19 who used the device more than 6 hours
per night (optimal users).
Zimmerman’s team found that 21 percent of poor users, 44 percent of moderate users, and 68
percent of optimal users achieved normal memory performance after 3 months.
“The information obtained from these results could be used as a potential motivator for sleep
apnea patients struggling with poor positive airway pressure adherence,” the investigators suggest.
SOURCE: Chest, December, 2006.

Friday, April 20, 2007
NEW YORK (Reuters Health) - The more alcoholic drinks that men have at any time of day -- not
just before bedtime -- the greater are the risks of breathing problems during sleep, a new study
shows. However, this effect was not seen among women.
Sleep-disordered breathing has been associated with high blood pressure and blood vessel
disease, and many studies have found that drinking alcohol before going to sleep increases the
likelihood of abnormally shallow breathing or even episodes in which breathing stops, Dr. Paul E.
Peppard and colleagues from the University of Wisconsin-Madison report.
However, whether or not light-to-moderate drinking, at any time of the day, affects breathing during
sleep has not been clear, they report in the Journal of Clinical Sleep Medicine.
To investigate, the researchers looked at 775 men and 645 women participating in a sleep study.
Two hundred eighty-one men (36 percent) and 332 women (51 percent) did not drink. The majority
of the rest (42 percent of men and 41 percent of women) reported, on average, having less than
one drink per day.
The subjects consumed two or fewer drinks in the afternoon of the days that the evaluation was
done. All of the subjects had been reporting their drinking habits for five years before their
breathing was evaluated, and
After the researchers accounted for the effects of body size, smoking and medications that can
cause breathing problems, they found that for every additional drink a man habitually took per day,
his risk of sleep-disordered breathing increased by 25 percent.
No such relationship was seen among women, which could have been because only 10 percent of
the women reported having an average of more than one drink per day, the researchers note.
There is also evidence that women may be less vulnerable to the effects of alcohol on breathing.
Men who were moderate drinkers were more likely to have five or more episodes of interrupted
breathing per hour during sleep than men who didn't drink at all.
This level of sleep-disordered breathing is seen in one of every four men in the United States, the
researchers note, and "this 'mild' degree of sleep-disordered breathing is associated with
cardiovascular and behavioral outcomes."
The investigators conclude that "men with sleep-disordered breathing and those at risk for
sleep-disordered breathing (are) advised to minimize alcohol consumption regardless of proximity
to bedtime."
SOURCE: Journal of Clinical Sleep Medicine, April 15, 2007.

Ontario, Canada - June 17, 2001
According to the United States Census Bureau, motor vehicle crashes are the leading cause of
injury morbidity and mortality in the United States. There are approximately 6 million injuries and
more than 40,000 deaths each year. It is estimated that sleep-related accidents comprise 15-20%
of all motor vehicle crashes, resulting in thousands of serious injuries and death. Certainly not all
sleep-related accidents are related to sleep disorders -- many are the result of simple sleep
deprivation.
Studies have shown, however, that persons with untreated sleep apnea are more likely to have
automobile accidents than persons without sleep apnea. Apnea patients who have been effectively
treated have reported that they experience fewer accidents and improved driving. Researchers at
the University of Western Ontario in London, Ontario, led by Charles F. P. George, M.D., decided
to confirm these self-reports with an objective study. Their results were recently published in Thorax
2001; 56: 508-512.
These results confirm that treatment of patients with sleep apnea would reduce their risk of serious
motor vehicle crashes to a rate similar to the general driving population.
For the study, 210 patients with obstructive sleep apnea (OSA) were treated with continuous
positive airway pressure (CPAP) for at least 3 years. These patients had a mean age of 52, a body
mass index of 35.5 and an apnea/hypopnea index of 54 events per hour. An equal number of
randomly selected control drivers were also identified.
Using official driving records from the Ontario Ministry of Transportation, motor vehicle collision
rates were then compared for 3 years before and after CPAP therapy for both patients and the
control drivers.
Untreated patients with OSA had more motor vehicle collisions than controls. The rate of collisions
per driver per year was .18 for the untreated patients, and .06 for the controls. The untreated
apnea patients had three times the number of accidents as the controls.
Following CPAP treatment, the number of collisions per driver per year fell to normal (.06) while, in
controls, the collision rate was unchanged over time. There were 27 patients who were not using
CPAP following diagnosis. The collision rate in those untreated patients remained high over time.
The authors conclude that patients with untreated sleep apnea have increased motor vehicle
crashes, but this rate decreases to normal once patients are treated with CPAP.
The authors also note that "not all patients with sleep apnea actually have collisions. In this study
more than half of the patients never had any collisions either before or after treatment."
Such results should be of great value to practicing physicians who must make assessments about
ability to drive as any restrictions on driving because of OSA could be safely removed after
treatment, they add.
In an editorial published in the same issue of Thorax, Drs. L. J. Findley and Paul M. Suratt discuss
the economic consequences of the findings. They estimate that treating 500 patients in the US for 3
years would likely prevent 180 serious crashes, with 36 serious injuries. The costs of those 180
accidents were estimated to be $369,000 in direct property damage and medical expenses and
some $648,000 in lost wages, legal expenses, and administrative costs of both government and
insurance companies. That's a total economic savings of over $1 million dollars for each 500
treated patients.
It is generally estimated that over 80-90% of sleep apnea patients remain undiagnosed and
untreated, with the number of untreated patients in the 12-15 million range.
Suratt and Findley conclude that "Preventing serious motor vehicle crashes by treating sleep
apnea is beneficial to everyone. For drivers with sleep apnea and those they injure, it avoids injury
and death and loss of wages and property. For insurance companies and employers it eliminates
the economic consequences of these problems. Unfortunately, some government agencies and
insurance companies have arbitrary and shortsighted policies which limit treatment for people with
sleep apnea. These obstacles, like dangerous objects on a highway, may contribute to serious and
costly motor vehicle crashes."