CPAP Blog

Bill Bolton, a bit of a sleep forum legend, posted this interesting bit of research, published in the American Journal of Respiratory and Critical Care Medicine. Universities around the world combined efforts to establish the ease of access to diagnosis and treatment of patients with suspected sleep apnoea.

I can tell you the not-so-surprising results in one short sentence. The UK comes out worst!

With 84 sleep labs on just short of sixty million people and in those clinics just 170 polysomnography beds we are nowhere near as well equipped to handle the growth in OSA prevalence as nations like Belgium, Australia or Canada.

They estimated some 25,000 new patient sleep studies (that’s not including necessary follow-ups for existing OSA patients) per year, or 42.5 studies per 100K population. In the other countries featured, this number is higher yet they all cope much better in terms of raw numbers.

It gets worse… Waiting times in the UK (as we know) are off the scale. Where in Belgium a suspected patient can expect to be tested and treated in around 2 months, in the UK it can vary from between 7 and 60 (!) months. In other words, between half a year and 5 years! In Australia and the US you would also have to be unlucky to wait more than a year.

The research abstract puts it as follows:

Waiting times vary widely across the country with no clear geographic trends. The average time for a nonurgent referral to be seen by a specialist is around 6 months (range, 2–24 months) and for a sleep study thereafter around 4 months (range, 0–48 months). Thereafter the delay for a CPAP titration is 4 months (range, 3–6 months). Thus, the overall wait from referral to CPAP averages approximately 14 months.

At the current rate, if you insist on public services instead of private, your wife gets to enjoy 14 months of more snoring and you get to live the regrets of 14 months more of walking around with potentially fatal blood oxygen levels.

At the Edinburgh Royal Infirmary the routine works out like this:

General practitioners refer half of the patients to this service and hospital specialists the other half. Sleep studies are ordered by one of two sleep physicians. To deal with the mismatch of demand and capacity, all referral letters are reviewed and prioritized by one of the sleep specialists. All patients living within 100 miles (160 km) are offered home-limited sleep studies, and only those with equivocal results get polysomnography. Patients living beyond 100 miles get split-night studies if their Epworth sleepiness score exceeds 11 (total score = 24) or if they report sleepiness when driving. Night nurses are cleared to start titrating CPAP if a sleepy patient’s apnea–hypopnea index (AHI) exceeds 20 after 2 hours of good sleep.

From that excerpt you can see that with a bit of exaggeration (inflated Epworth score or mention falling asleep when driving - may have licence implications though) you may get helped faster (referral priorization) and more thoroughly (full polysomnography). I don’t recommend gaming the system as you will delay others’ needs but you can see how and why people would.

Having said that, how it’s done in Edinburgh is not representative of the rest of the UK:

These practices differ from those elsewhere in the United Kingdom. Overall, in the United Kingdom around two thirds of all “sleep studies” are oximetry alone and 20% are limited sleep studies, with only 10% being full polysomnography studies. […] Oximetry alone studies are especially prevalent in England. Some general practitioners refer patients to otolaryngologists, who have no specific training in sleep, because of the long waiting times.

An otolaryngologist, for your information, is an Ear Nose and Throat (ENT) doctor. Fancy being diagnosed for your sleep issues by someone who knows more about ears than sleep? And by only measuring blood oxygen levels without looking at apnoea events?

If you are interested in how the other countries compare to ours, please continue reading here. This table tells it all it a nice format.

In summary for the UK with Canadian figures in brackets for comparison:

• Population: 58.8m (31.4)
• No. of sleep labs: 84 (100)
• No. of sleep beds: 170 (440)
• No. beds per 100,000 people: 0.3 (1.4)
• No. sleep studies per year: 25,000 (116,000)
• No. studies per 100,000: 42.5 (370.4)
• Waiting time in months: 7-60 (4-36)

Does this come as a surprise to you? What is the way forward? Are you contemplating moving after reading this? Whatever your thoughts, post them as a comment below or discuss your views in the forums.

If you suspect you, or someone you know, may be suffering from sleep apnoea then please take this questionnaire which will help determine whether this is indeed the case. It may take away some of the doubts you may have.

The BBC reports that those who don’t get enough sleep (as well as those with too much) double their risk of cardiovascular disease. The article quotes research from the University of Warwick and University College London regarding death rates over two decades among over ten thousand civil servants.

The risk of heart disease doubled among those who slept just 5 hours a night compared to those on 7 hours. Interestingly, a similar increase in risk was found among those sleeping 8 or more hours each night.

Those who cut their sleeping from seven to five hours a night had twice the risk of a fatal cardiovascular problem of those who stuck to the recommended seven hours a night - and a 1.7 increased risk of death from all causes.

Researchers also linked the lack of sleep with an increased risk of weight gain, high blood pressure and type 2 diabetes. Considering most obstructive sleep apnoea patients tend to be overweight, with high blood pressure and a lot of them pre-diabetic, linking OSA wouldn’t be that far-fetched either.

Even when a sleep apnoea patients spends 7 hours in bed with his or her eyes shut, you can argue getting just 4 to 5 hours sleep effectively, taking into account the apnoea events, repeated waking up and stress on the body. Untreated obstructive sleep apnoea therefore means sub 7 hours sleep and hence double the risk of fatal cardiovascular problems.

Dr Neil Stanley, a sleep expert from Norfolk and Norwich University Hospital, said while public health messages focused on diet and exercise, people were given very little information about the need to get proper amounts of sleep.

I agree wholeheartedly with Dr Stanley. Articles in main stream media like this one on the BBC website help raise awareness of sleep problems such as sleep apnoea. I hope people who recognise the symptoms and habits mentioned take pro-active action and get a sleep study done at their nearest clinic and seek suitable treatment such as Continuous Positive Airway Pressure (CPAP).

Steve Poceta from over at Revolution Health posted his views on this matter here.

CPAP in the news again. This time, we’re at the WorldSleep07 in Cairns, where Dr Monica Anderson spoke about how chronic sleep deprivation, as experienced by sleep apnoea sufferers, causes erectile dysfunction and lower libido. I guess one of those things we all know about but not hear about from the experts very often.

Dr. Anderson is a sexual health expert from Brazil and has done research proving that sleep deprivation and extreme or persistent body clock disruption has a negative impact on our sex life. In the press article, she goes on to say that some men may get so deprived of sexual activity they may develop a rare and disturbing condition called sexomnia, when their libido is heightened and initiate sex while asleep.

The article continues to say…

Studies have proven that those who are sleep deprived, particularly those with disrupted body clocks, have a much poorer libido in general.

The same complaints come from men with the night-time breathing problem, sleep apnoea, who need treatment with continuous positive airway pressure (CPAP) to help restore their erectile function.

“This is a sad product of the busy 24-hour life that we’re living now,” Prof Andersen said.

So there you have it. Not only does CPAP help OSA patients with sleep, it also aids in other areas concerning bedroom activities. I wonder how long before spammers send me e-mails pitching the latest REMStar as oppose to the infamous “V” pills that solve similar issues