Facts and Fig­ures

Indonesia Expat - - HEALTH -

What is sleep-dis­or­dered breath­ing (SDB)?

SDB de­scribes a num­ber of noc­tur­nal breath­ing dis­or­ders: Ob­struc­tive sleep ap­nea (OSA)

Cen­tral sleep ap­nea (CSA)

Noc­tur­nal hy­poven­ti­la­tion

Cheyne–Stokes res­pi­ra­tion (CSR)

What is ob­struc­tive sleep ap­nea (OSA)?

The most com­mon form of SDB

A par­tial or com­plete col­lapse of the up­per air­way caused by re­lax­ation of the mus­cles con­trol­ling the soft palate and tongue

Per­son ex­pe­ri­ences ap­neas, hy­pop­neas and flow lim­i­ta­tion Ap­nea: a ces­sa­tion of air­flow for ≥10 sec­onds

Hy­pop­nea: a de­crease in air­flow last­ing ≥10 sec­onds with a 30 per­cent re­duc­tion in air­flow and at least a three per­cent oxy­gen de­sat­u­ra­tion from base­line

Flow lim­i­ta­tion: nar­row­ing of the up­per air­way and an in­di­ca­tion of an im­pend­ing up­per air­way clo­sure

Signs and symp­toms of sleep ap­nea?

Lack of en­ergy

Morn­ing headaches

Fre­quent noc­tur­nal uri­na­tion


Ex­ces­sive day­time sleepi­ness (EDS)

Night­time gasp­ing, chok­ing or cough­ing Gas­troe­sophageal re­flux (GE re­flux)

Ir­reg­u­lar breath­ing dur­ing sleep (e.g., snor­ing)

Clas­si­fi­ca­tion of sleep ap­nea

Ap­nea–hy­pop­nea in­dex ( AHI)

Num­ber of ap­neas and/or hy­pop­neas per hour of sleep (or study time)

Re­flects the sever­ity of sleep ap­nea

AHI: < 5 Nor­mal range

AHI: 5 to < 15 Mild sleep ap­nea

AHI: 15 to < 30 Mod­er­ate sleep ap­nea

AHI: ≥ 30 Se­vere sleep ap­nea

Preva­lence of sleep ap­nea

Ap­prox­i­mately 42 mil­lion Amer­i­can adults have SDB1 An es­ti­mated 26 per­cent of adults have at least mild SDB2 Nine per­cent of mid­dle-aged women and 25 per­cent of mid­dle-aged men suf­fer from OSA3

Preva­lence in the US is sim­i­lar to asthma ( 20 mil­lion) and di­a­betes ( 23.6 mil­lion)

75 per­cent of se­vere SDB cases re­main un­di­ag­nosed5

In­creased risk fac­tors for sleep ap­nea

Obe­sity (BMI >30)

Di­ag­no­sis of hy­per­ten­sion

Large neck cir­cum­fer­ence (>17” men; >16” women) Male gen­der

Ex­ces­sive use of al­co­hol or seda­tives

Up­per air­way or fa­cial ab­nor­mal­i­ties


Fam­ily his­tory of OSA

En­docrine and meta­bolic dis­or­ders

Car­dio­vas­cu­lar links

5.1 mil­lion peo­ple in the US have heart fail­ure14 Ap­prox­i­mately 76 per­cent of con­ges­tive heart fail­ure pa­tients have SDB8

Heart fail­ure is the most ex­pen­sive dis­or­der to treat15

OSA noted in 49 per­cent of atrial fib­ril­la­tion pa­tients10 and 30 per­cent of car­dio­vas­cu­lar pa­tients13

OSA presents in 70 per­cent of heart at­tack pa­tients with

AHI ≥5 and 52 per­cent of heart at­tack pa­tients with AHI ≥1016

Hy­per­ten­sion links

Stud­ies have shown that sleep ap­nea is an in­de­pen­dent risk fac­tor for hy­per­ten­sion

30–83 per­cent of pa­tients with hy­per­ten­sion have sleep ap­nea

43 per­cent of pa­tients with mild OSA and 69 per­cent of pa­tients with se­vere OSA have hy­per­ten­sion5

AHA guide­lines on drug-re­sis­tant hy­per­ten­sion have shown that treat­ment of sleep ap­nea with CPAP is likely to im­prove blood pres­sure con­trol

Type 2 di­a­betes links

48 per­cent of type 2 di­a­betes suf­fer­ers have sleep ap­nea11 OSA may have a causal role in the de­vel­op­ment of type 2 di­a­betes17

OSA is as­so­ci­ated with in­sulin re­sis­tance (in­de­pen­dent of obe­sity)

30 per­cent of pa­tients pre­sented to a sleep clinic have im­paired glu­cose in­tol­er­ance19

Mild forms of SDB may be im­por­tant in pre­dict­ing risk of pre-di­a­betes20

86 per­cent of obese type 2 di­a­betic pa­tients suf­fer from sleep ap­nea21

Stroke risk

65 per­cent of stroke pa­tients have SDB22

Mod­er­ate to se­vere sleep ap­nea triples stroke risk in men23

Mor­tal­ity links

SDB is as­so­ci­ated with a three­fold in­crease in mor­tal­ity risk5

There is an in­de­pen­dent as­so­ci­a­tion of mod­er­ate to se­vere OSA with in­creased mor­tal­ity risk3

Se­vere sleep ap­nea raises death risk by 46 per­cent24

Health care costs (eco­nomic con­se­quences of un­treated SDB)

Pa­tients with un­treated OSA had 82 per­cent higher in­pa­tient hos­pi­tal costs than treated pa­tients25

Pa­tients with OSA have higher util­i­sa­tion rates and in­cur greater costs than non-OSA pa­tients for up to ten years prior to di­ag­no­sis26

OSA pa­tients on PAP ther­apy have 31 per­cent lower to­tal med­i­cal costs than pa­tients not on PAP ther­apy25

Traf­fic ac­ci­dents

In the year 2000, 810,000 US driv­ers were in­volved in a mo­tor ve­hi­cle ac­ci­dent re­lated to OSA – 1,400 in­volved fa­tal­i­ties27

Treat­ing all US driv­ers suf­fer­ing from sleep ap­nea would save US$ 11.1 bil­lion in col­li­sion costs and save 980 lives an­nu­ally27

Treat­ment of OSA with CPAP

CPAP treat­ment re­duces the need for acute hos­pi­tal ad­mis­sion due to car­dio­vas­cu­lar dis­ease in pa­tients with sleep ap­nea28

CPAP re­duces blood glu­cose lev­els29

Two nights of CPAP im­proves in­sulin sen­si­tiv­ity, sus­tained at the three-month in­ter­val30

For every dol­lar spent on CPAP, US$ 3.49 would be saved in re­duced col­li­sion costs27

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