Mayo Clinic physicians offered updates about diagnosing and treating patients with a
variety of sleep disorders, including obstructive sleep apnea and sleep
behavior disorders, at CHEST 2007, the annual meeting of the American
College of Chest Physicians in Chicago on Oct. 20-25. The following are
brief summaries of select presentations.
More than 12 million people in the United States have obstructive sleep
apnea, a potentially serious disorder in which breathing repeatedly stops
and starts during sleep when the throat muscles relax
People with the rapid eye movement (REM) sleep disorder known as REM
behavior disorder (RBD) sometimes act out their dreams by yelling or moving
violently during REM sleep. A rare condition, RBD affects between 0.4
percent and 0.5 percent of the population.
Each year, physicians at Mayo Clinic's campuses in Arizona, Florida and
Minnesota treat thousands of patients who have sleep disorders. For more
information on the treatment of sleep disorders at Mayo Clinic, visit
http://www.mayoclinic.org/sleep-disorders/.
Obstructive Sleep Apnea Linked with Cardiovascular Problems
Daytime fatigue, sleepiness and sleep-deprived bed partners are several
symptoms commonly observed in patients with obstructive sleep apnea. More
serious, however, are the cardiovascular problems associated with this
sleep disorder.
Mayo Clinic pulmonologist Kannan Ramar, M.B.B.S., M.D., describes how
physiological changes that occur during obstructive sleep apnea episodes
affect the cardiovascular system. Sudden drops in blood-oxygen levels
increase blood pressure and strain the cardiovascular system. About half of
those with sleep apnea develop high blood pressure (hypertension), which
raises their risk of heart failure and stroke. Obstructive sleep apnea may
be associated with strokes, coronary artery disease and metabolic problems
such as diabetes. Repeated multiple episodes of low blood oxygen (hypoxia
or hypoxemia) can also lead to sudden death from a cardiac problem in
people with underlying heart disease. Also, there is a strong association
between obstructive sleep apnea and dangerous heart rhythm changes
(dysrhythmias).
"Mounting data suggests that obstructive sleep apnea contributes to
cardiovascular disease, independent of obesity and other cardiovascular
risk factors," explains Dr. Ramar. "Considering that obstructive sleep
apnea is treatable, establishing causality with other cardiovascular
disorders has far-reaching implications. Long-term studies are needed to
assess the impact that treatment with continuous positive airway pressure
(CPAP)and other treatment modalities has upon cardiovascular outcomes."
CPAP therapy is a preferred method of treating sleep apnea. A machine
delivers air pressure through a mask placed over the nose during sleep.
CPAP elevates the air pressure in the upper airway passages slightly to
keep these passages open, and to prevent apnea and snoring.
Consensus needed on treatment options for obstructive sleep apnea
Mayo Clinic pulmonologist Peter Gay, M.D., discusses trends in the care
of people with obstructive sleep apnea. Dr. Gay notes that while experts
now universally accept the need to consider this condition as a chronic
disease, more research and discussion is needed to establish consensus
about the best and most practical way to manage the long-term care for
people with this disorder.
"Given that the use of CPAP therapy can be challenging for a large
minority of patients (up to 30 percent to 40 percent), we need research to
address several questions related to how we may better optimize adherence
to therapy," explains Dr. Gay. "Asking 'How important is the immediate or
near-immediate introduction of continuous positive airway pressure (CPAP)
therapy in these patients?' and 'How early and frequently should these
patients be seen in follow-up?' is important. Answering these questions
will help us refine our chronic care plans and give further insight into
how we may reduce several conditions such as cardiovascular disease, mood
disorders, and accidents, all of which are associated with sleep apnea."
Rare Sleep Disorder Marked by Excessive and Sometimes Violent Movements
People with RBD might yell or move excessively during sleep. According
to Mayo pulmonologist John Park, M.D., these episodes occur when the muscle
paralysis normally present during rapid eye movement (REM) sleep is
incomplete or absent, allowing the person to physically act out his or her
dreams.
"This condition is usually brought to our attention when a bed partner
reports being struck or physically harmed or observes the patient harming
himself or herself in the midst of a dream enactment," says Dr. Park.
Dr. Park notes that while the symptoms of RBD can be alarming, the
disorder can be treated. Sometimes the behavior is related to untreated
sleep apnea and the condition resolves with regular sleep apnea treatment.
For RBD where the cause is unknown (idiopathic RBD), treatment usually
includes making the sleep environment safer, and use of medications,
depending on the severity of episodes.
Seeking treatment for RBD also allows the patient to be monitored for
signs of neurological disorders such as Parkinson's disease and other forms
of dementia, which some patients with RBD have or develop later.
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