While efforts to reduce fatigue in aviation have focused on pilots' schedules, federal accident investigators say pilots and other vehicle operators also need to be screened for sleep disorders. The National Transportation Safety Board (NTSB) is preparing to take a stand on the issue within weeks, according to testimony at a recent public meeting.
Showing posts with label sleep apnea. Show all posts
Showing posts with label sleep apnea. Show all posts
Saturday, July 25, 2009
Sleep Disorders Linked to Aviation Accidents
Sleep disorders, especially obstructive sleep apnea, are common among truck drivers. USAToday reports that the National Transportation Safety Board is investigating fatigue as a cause of accidents in the aviation industry:
Tuesday, April 17, 2007
REM-related obstructive sleep apnea
A reader (Franto) asks "Sorry to butt in with this question for you! I had a recent sleep study that showed I am getting v little REM sleep because I start getting hypopneic as soon as I enter into REM and have an arousal. Overall there was little obstruction and no apnea (lowest O2 sat was 91%). The problem was entirely REM specific, and I had good deep sleep. My total REM percentage was only 6.5%. There apparently were several aborted REM episodes. The reason I had the study done was that I have been having unrefreshing sleep and working memory issues for a few years now! My sleep physician wants me to do CPAP study to see if it helps improve my REM. My Q to you is if you see cases like mine at all, since I havent read about such a selective REM condition on the web or Pubmed. I know about UARS but that too involves both REM and NREM. Would CPAP help in such a situation?"
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Some people have OSA primarily during REM sleep. I found the following in Sleep Medicine Pearls, by Richard B. Berry, MD (2nd edition, page 118):
In patients with excessive daytime sleepiness and significant, REM-specific sleep apnea, treatment is indicated. Other possible causes of daytime sleepiness should be excluded.
The reason for the higher AHI during REM sleep are commplex. REM sleep is not homogenous, and episodes of decreased upper airway muscle activity or ventilatory drive may be the cause of hypopneas or apneas during REM sleep.
In my experience, in many people, OSA is worse during REM sleep. It is unusual for sleep apnea to occur exclusively during REM, but it is possible. I think your sleep physician's advice is reasonable and CPAP is worth a try.
_____________________
Some people have OSA primarily during REM sleep. I found the following in Sleep Medicine Pearls, by Richard B. Berry, MD (2nd edition, page 118):
In patients with excessive daytime sleepiness and significant, REM-specific sleep apnea, treatment is indicated. Other possible causes of daytime sleepiness should be excluded.
The reason for the higher AHI during REM sleep are commplex. REM sleep is not homogenous, and episodes of decreased upper airway muscle activity or ventilatory drive may be the cause of hypopneas or apneas during REM sleep.
In my experience, in many people, OSA is worse during REM sleep. It is unusual for sleep apnea to occur exclusively during REM, but it is possible. I think your sleep physician's advice is reasonable and CPAP is worth a try.
Monday, February 26, 2007
sleep apnea and cardiovascuar disease
The evidence linking obstructive sleep apnea to cardiovascular disease continues to grow. Obstructive sleep apnea (OSA) is a thought to be a risk factor for the development of hypertension, stroke, coronary artery disease, and congestive heart failure. The evidence is strongest for hypertension. A recent study adds to the evidence linking OSA to stroke:
But the real question, Dr. Mohsenin said, is whether there is an independent association between sleep apnea and stroke, and a recent study on which he was an author shows that there is indeed such an association.
In the observational cohort study of 697 patients with obstructive sleep apnea and 325 controls (mean apnea-hypopnea index of 35 vs. 2 in the patients and controls, respectively), obstructive sleep apnea was found to have a statistically significant association with stroke or death (hazard ratio of 1.91) after adjustment for numerous factors, including age, sex, race, smoking status, alcohol consumption, body mass index, diabetes, hyperlipidemia, atrial fibrillation, and hypertension.
A trend analysis also showed a significant dose-response relationship between sleep apnea severity at baseline and development of a composite end point of stroke or death from any cause (N. Engl. J. Med. 2005;353:2034–41).
While randomized controlled trials are needed to firmly establish a causal link between sleep apnea and stroke—to “put the last nail in the coffin and say, ‘ok, sleep apnea is indeed a cause of stroke in a high-risk patient population,’” as Dr. Mohsenin put it, the findings increasingly suggest this is the case. Also, sleep apnea occurs as commonly in transient ischemic attack as it does in stroke, further underscoring the need for sleep apnea treatment in affected patients, he noted.
Additionally, a number of studies have shown that sleep apnea is associated with worse functional outcomes in stroke patients, Dr. Mohsenin said.
Patients with stroke who have sleep apnea have been shown to have more delirium, depression, impaired functional capacity, longer rehabilitation time, and longer hospitalization, he said.
“Sleep apnea does affect the outcome of stroke,” he said, noting that in some studies these effects lasted out to 12 months.
Patients who have had a stroke should be evaluated for sleep disordered breathing, he advised.
In the observational cohort study of 697 patients with obstructive sleep apnea and 325 controls (mean apnea-hypopnea index of 35 vs. 2 in the patients and controls, respectively), obstructive sleep apnea was found to have a statistically significant association with stroke or death (hazard ratio of 1.91) after adjustment for numerous factors, including age, sex, race, smoking status, alcohol consumption, body mass index, diabetes, hyperlipidemia, atrial fibrillation, and hypertension.
A trend analysis also showed a significant dose-response relationship between sleep apnea severity at baseline and development of a composite end point of stroke or death from any cause (N. Engl. J. Med. 2005;353:2034–41).
While randomized controlled trials are needed to firmly establish a causal link between sleep apnea and stroke—to “put the last nail in the coffin and say, ‘ok, sleep apnea is indeed a cause of stroke in a high-risk patient population,’” as Dr. Mohsenin put it, the findings increasingly suggest this is the case. Also, sleep apnea occurs as commonly in transient ischemic attack as it does in stroke, further underscoring the need for sleep apnea treatment in affected patients, he noted.
Additionally, a number of studies have shown that sleep apnea is associated with worse functional outcomes in stroke patients, Dr. Mohsenin said.
Patients with stroke who have sleep apnea have been shown to have more delirium, depression, impaired functional capacity, longer rehabilitation time, and longer hospitalization, he said.
“Sleep apnea does affect the outcome of stroke,” he said, noting that in some studies these effects lasted out to 12 months.
Patients who have had a stroke should be evaluated for sleep disordered breathing, he advised.
That the treatment of OSA improves cardiovascular outcomes is an unproven assumption. We know that in sleep apnea patients, CPAP can improve cardiac functioning (ejection fraction) and reduce blood pressure. However, it has not been proven that CPAP improves mortality or decreases the rate of myocardial infarction. A randomized controlled trial looking at this question would be difficult to carry out.
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