Susan Redline, MD, MPH
Sleep apnea is actually a very common condition, and it's a condition that occurs because the throat during sleep collapses repetitively at night. And when the throat collapses we make that sound that many of us could recognize as snoring. But what happens with a complete collapse of the throat at night, oxygen levels drop and also the brain's sleep continuity is interrupted, so sleep gets disrupted.
Sleep apnea can affect children, middle-aged individuals and elderly people, men and women. The group of adults who appear to be at greatest risk are often middle-aged older men and individuals who are overweight. But as I said, it can affect anyone, and in fact, in women after menopause the rates of sleep apnea go up quite a bit, as well.
Over the last 10 years, there's been a tremendous amount of research that studied the links between sleep apnea and a number of health outcomes. There is unequivocal data that sleep apnea is associated with a marked increased risk of stroke, about three-fold higher, of heart failure, coronary artery disease and diabetes.
A full overnight sleep study in a laboratory is, in fact, the way to get the most comprehensive data on your sleep quality, as well as your breathing, your leg movements and your heart rate overnight.
Those studies we do in more complicated patients, for example, patients who have sleep apnea and a concern about maybe a leg movement disorder or heart failure.
The home sleep studies are a much simplified version of the laboratory studies. And in the home studies we often simply measure breathing pattern by a small cannula that's worn under the nose almost like an oxygen cannula, a couple of bands around the chest and stomach that measure breathing pattern and a finger pulse oximeter. And just those few sensors that can be self-applied by the patient, we can actually get a fairly good estimate of breathing pattern and oxygenation and heart rate overnight, which is usually sufficient to make a diagnosis of sleep apnea.
The most established treatment is something called positive airway pressure. And this was a treatment that was invented about 30 years ago or so and it's a very simple treatment where basically, air is delivered to the throat and nose under some positive pressure and simply prevents the throat from collapsing. And we really hope to achieve as much usage as possible, because we believe from the data we collect the more time you use CPAP, the better health benefit you get.
For example, our group at the Brigham and Women's Hospital recently completed a study where we compared CPAP use in patients with underlying heart disease risk factors, plus sleep apnea, who were getting standard support for their CPAP, versus special behavioral support by a trained psychologist who worked at really troubleshooting and providing educational type support, something we call cognitive behavior therapy. And patients who got that extra support use CPAP over an hour per night longer than the usual group.
We study everything from the genetics of sleep apnea, through comparative effectiveness work that looks at alternative treatments and their effect on street apnea, to population studies looking at what subgroups seem to be most susceptible to sleep apnea.
And as we started studying sleep apnea we saw by all means it runs in families, such that if you have a family member with sleep apnea you’re between 50 percent and three fold more likely to have sleep apnea, compared to someone who doesn’t have a family member with sleep apnea.
We've been studying large groups of children and adults across the U.S. to find out what are some of those risk factors other than obesity that may influence sleep apnea and how those risk factors may actually vary if you’re younger or older or you’re a male or you’re a female. So for example, one of the outcomes of our group was to find that those individuals, especially children and young adults living in distressed neighborhoods had increased rates of sleep apnea. And that’s made us look more closely at some of the environmental exposures that may actually change inflammation of the nose and throat and otherwise may increase risk of sleep apnea.
Our most recent work which is very exciting really relates to a big national effort to engage patients in the research itself. And that is our patient powered research network, called MyApnea.org.
We’re directly inviting patients to be part of the research team, so not just as consultants but actually a co-investigator, a co-developer and asking patients, what questions they think are most relevant for sleep apnea and what studies do they think are going to be most impactful and furthermore, what studies will be most feasible.
So through a patient centered outcome initiative and MyApnea.org, which we call patient-powered research, we’re trying to build a completely new infrastructure and a completely new paradigm for doing research.
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