CPAP Blog

RoadTransport.com today reports that eight in ten of male truck drivers in the UK are overweight. In the article, a health education warns truckers must improve their lifestyle or face serious consequences.

“The results are a cause for concern because they indicate that there is a very high percentage of drivers on the road whose health makes them a potential hazard. A waist measurement of 40 inches or more and a Body Mass Index of 30 or more can spell danger because both are indicators of a high risk of Type 2 diabetes, which in turn can trigger sleep apnoea.”

That seems to be what caused three deaths earlier in the year, when a trucker slammed into a traffic jam. The lorry driver was later diagnosed with severe sleep apnoea but let off by the jury because at the time he didn’t know he had sleep problems.

Road Transport further reports:  The average age of drivers surveyed was 51 but on average they had the metabolism of someone two years older. Average height was 5ft 8in (177.5cm) average weight was 14.4 stone (91.6kg) and average waist was 40.5in. The survey also found that most had a high pulse rate and BMI.

These measurements will sound familiar to most CPAP users and Obstructive Sleep Apnoea sufferers. Whilst being overweight is by no means the only cause of OSA, it does appear to be the most contributing factor in the majority of cases.

The good news is that almost all drivers welcomed regular health checks including blood pressure, blood sugar levels, cholesterol levels, waist measurement and body mass index. Add to this blood oxygen saturation and you have a decent setup for screening these people who may be posing a serious threat to fellow road users. Had this been in place already, perhaps the accident mentioned above could have been prevented.

If you drive a lot and suspect sleep related breathing trouble, please read the following blog post here on the CPAP blog: Sleepy Driving and Sleep Apnoea

I also recommend  visiting osaonline.com

Take the online sleep screening test if you are unsure about your what your symptoms could mean.

What happens when a computer science professor from Germany gets fed up with his own snoring? He puts his skills to good use and invents a computer controlled pillow which can help prevent snoring.

At a health conference in Germany, self-proclaimed snorer Daryoush Bazargani demonstrated his prototype.

He said: “The pillow is attached to a computer, which is the size of a book, rests on a bedside table, and analyses snoring noises.”

“The computer then reduces or enlarges air compartments within the pillow to facilitate nasal airflow to minimise snoring as the user shifts during sleep.”

He told Fibre2Fashion: “Optimal breathing position is the best position with the least snoring noise or help completely stopping snoring.”

With the automatic computer-controlled air pockets the head gets positioned in such a way that the airway stays open as much as possible to reduce the chance of snoring. The principle is fairly straight-forward. If the computer hears noise, it adjusts the pillow so the head tilts. If no snoring noises get recorded anymore, the head is in the best possible position. When you move around and start snoring again, the computer will adjust the pillow again.

This air pocket concept makes the pillow look similar to an actual CPAP machine. An air pump connects to the pillow via a tube. Perhaps the two can one day be integrated, if this variable pillow invention by Bazargani proves to be beneficial to sleep apnoea sufferers too.

In North America alone, people spend over $2.5 billion a year on sleeping aids so Professor Bazargani could be in for a winner with this innovative pillow, if clinical data support his claims. To take his pillow invention from prototype to the retail shelves, he is looking for investors for his project. This seems to have good potential, despite being based on thin air!

On October 10th, the National Institute for Health and Clinical Excellence (N.I.C.E.) holds the second appraisal committee meeting. This is an important step in N.I.C.E.’s appraisal of Continuous Positive Airway Pressure (CPAP) and its use in the NHS around the country.

The Department of Health recognizes the growth in obstructive sleep apnoea / hypopnoea syndrome prevalence and is seeking advice from expert consultants in regards to the way forward. It is no secret that allocated funds don’t meet demand for sleep apnoea treatment in England and Wales with many patients complaining about the current ‘postcode-lottery’ system.

At the first meeting the appraisal committee considered the evidence submitted and views put forward by consultees other than the CPAP manufacturers, who in fact are on the committee’s list of sources of evidence. Based on this, preliminary recommendations on the use of CPAP as a treatment for OSA have been put together. This second meeting will allow for comments on the preliminary recommendations and re-consider evidence submitted.

The Final Appraisal Determination (FAD) is scheduled for early next year.

The current recommendations, still subject to change read:

1	Appraisal Committee’s preliminary recommendations
1.1	Continuous positive airways pressure (CPAP) is recommended as a treatment option for people with moderate and severe symptomatic obstructive sleep apnoea/hypopnoea syndrome.
1.2	Continuous positive airways pressure (CPAP) is also recommended as a treatment option for people with mild symptomatic obstructive sleep apnoea/hypopnoea syndrome if lifestyle advice and any other relevant treatment options have been considered and deemed inappropriate or unsuccessful.
1.3	The diagnosis of obstructive sleep apnoea/hypopnoea, the prescription of CPAP treatment and monitoring of the initial response should be carried out by specialists in sleep medicine.

Point 1.1 doesn’t seem to be a big change. CPAP was already the recognised form of treatment for OSA prior to these meetings. Points 1.2 and 1.3 will have a greater impact on the health care system and service patients may come to expect.

It looks like the NHS will start to recommend CPAP based on a lower symptoms threshold. Where previously you had to be diagnosed with severe sleep apnoea (breathing lapses of over 10 seconds many times every hour) it looks as if this requirement will be lowered to include those with milder forms of obstructive sleep apnoea, like those with shorter apnoea events or fewer. If this recommendation goes through, this could mean many more people being diagnosed and needing treatment so one would hope more funds will become available to pay for this increased demand.

Point 1.3 may have implications on the current bottleneck that is diagnosis. Where elsewhere in the world stakeholders have been discussing the appropriateness of in-home testing with portable diagnostics devices such as Respironics’ Stardust or ResMed’s ApneaLink, the NHS seems to favour clinical diagnosis. In-home testing could take the burden off busy sleep labs. By opening up CPAP treatment to more people we need more people diagnosed. Insisting on the conventional diagnosis route could mean a bigger bottleneck and reduced access to the actual therapy, considering a prescription is required. Some sleep labs charge over £1,000 for an overnight stay - an amount the average OSA patients is unable to stomach so waiting lists are bound to increase.

We will find out early 2008 whether these recommendations will make it into official Department of Health guidelines. I just hope they don’t make the problem bigger than it already is.

What do you think about these important developments? Leave a comment below or discuss in the forums.