diagnosis

Rapid Access to Sleep Services

We’re delighted to announce that our Adelaide Sleep clinic and sleep study services have been extended!

We now have more sessions available and can consult you within days.

Similarly, our sleep study (polysomnography) sessions have increased to almost every night of the week. We can accommodate your schedule much easier and sooner.

With our Rapid Access Sleep Services, we’ll be able to see you, study your sleep, and start treatment immediately.
And for our country patients travelling into Adelaide, we can even see you the following morning with your sleep study results, and start treatment that same day.

For local Adelaideans, your Sleep Study reports are often released to yourself and / or your referrer within 24-48hours of your sleep study.

At Adelaide Sleep, we don’t think it’s fair to make you wait days, weeks, months to have your sleep study. You shouldn’t have to wait for your results either. See us now.

© APSS 2016

Cancer and OSA – an unlikely link?

Does having Severe OSA increase your risk of Cancer? Looking back on the years of Obstructive Sleep Apnoea (OSA) research, we’ve been eagerly watching this unexpected link.

This association has not been studied widely. We’ve known for a long time that repeated intermittent hypoxaemia (low blood oxygen levels) can result in demonstrable problems to the human body – increasing your heart attack risk, stroke risk, Atrial Fibrillation risk, and even cognitive decline.

Martinez-Garcia et al has published both in the Am J Respir Crit Care Med (2013) and Sleep med (2014) with data suggesting those with OSA have an unusually high link to Cancer.

They found that Severe OSA measured by a drop in Oxygen Saturations below 90% (TSat90) and now the Apnoea Hypopnoea Index (AHI) is independently associated with increased cancer mortality. This was even after correcting for confounding variables, particularly true in those below the age of 65, and men.

This is however not a firm causal-link… but not beyond the realm of possibility. More research needs to be done in this field, and we’ll be watching that space closely. Drop us a line and we’ll be able to discuss your sleep in more detail.

Campos-Rodriguez, Martinez-Garcia et al. Am J Respir Crit Care Med. 2013.
Martinez-Garcia et al. Sleep Med. 2014.

© APSS 2016

45% of those with heart disease have OSA

OSA has long been known to increase your Cardiovascular (heart attack) and Cerebrovascular (stroke) risk. The constant drops in your oxygen levels known as desaturations, cortical arousals, and cardiovascular responses can have significant detrimental effects on your cardiac state, and predispose to heart disease.

We’ve known about this link for a long time, and we’ve advocated screening for OSA in all people with heart disease.

A recent multicentre observational study by Furlan et al (1) has confirmed the extremely high prevalence of OSA in those with known Coronary Artery Disease.

The study looked at over 1300 adults over the age of 18 from another multicentre study (Sleep and Stent Study), across multiple countries. These adults underwent percutaneous coronary intervention (PCI) for known coronary artery disease – ie. atherosclerosis, blockages inside their coronary arteries, angina, and heart attacks.

OSA was found in 45% of individuals with Coronary Artery Disease!

Given this extremely high prevalance of OSA, we highly recommend you have an in-hospital Sleep Study if you have Coronary Artery Disease, including:

•  Atherosclerosis
•  A history of angina or heart attacks
•  Coronary blockages needing ballon / stent insertion
•  Coronary bypass surgery

 Your heart health is important to us. Contact us now for an appointment.

 

1. Furlan et al. Am J Respir Crit Care Med. 2015.

© APSS 2015

RLS Treatment associated with gambling, Impulse Control Disorders

One of the most common sleep disorders is The Restless legs Syndrome (RLS), and one of the common treatments is associated with Gambling and Impulse Control Disorders (ICDs).

RLS is a common sensorimotor disorder, typically amenable to treatment with dopamine agonist therapy. Dopamine agonists are mainly used for Parkinson Disease, but they have an important role in treating RLS.

These medications include pramipexole (Sifrol), ropinirole (Repreve), cabergoline (Cabaser, Bergoline), pergolide (Permax), and levodopa (Kinson, Madopar).

One of the unfortunate unpredictable side effects is that of Impulse Control Disorders (ICDs). These include :

•  Compulsive gambling (casino, pokies, tele-lotteries)
•  Compulsive shopping
•  Hypersexuality
•  Intermittent Explosive Disorder
•  Punding
•  Kleptomania (stealing)

More recently, there have been legal proceedings regarding some medications and ICDs.

We’ve known about this for some time, and we published the first Australian cohort of RLS patients with ICDs. We’ve looked after one of the largest groups of RLS patients in Australia, we routinely manage these problems effectively, and can adjust medications / medication-types as required.

RLS is easy to treat, and also easy to monitor even in the setting of potential side effects. And if Dopaminergic agents are not suitable, we have many more alternative medications at hand.

Call us now if you’d like to discuss this further.

© APSS 2015

Fixing Sleep in teenagers and adolescents

Sleep problems exist at every age group, and that’s why we’re delighted to remind everyone that we not only consult adults, but also adolescents above the age of 14years. The sleep needs of your Teenager should be as tailored to them as it would to any Adult. Sleep in Teenagers is unique.

Adolescents aren’t just ‘little adults’. Their problems are specific in their age group, and are well and truly above and beyond a simple ‘sleep apnoea’ test. They shouldn’t be treated just like any other adult.

In the younger age group, there is a higher propensity for Central Hypersomnias (including Narcolepsy and Idiopathic Hypersomnolence). They’re more likely to experience NREM parasomnias, sleep walking and sleep talking, night terrors and arousal disorders. Their Circadian Rhythm is more likely to be reflective of Delayed Sleep Phase Syndrome, or Free Running Rhythm (now known as Non-24-Hour Sleep-Wake Rhythm).

Increasingly we’re seeing more and more of those with Periodic Limb Movements or The Restless Legs Syndrome too.

Home sleep studies are restricted to those above 18yo, and often have no consultation with any specialist of any kind. That’s why we prefer in-hospital studies, and our specialists will always personally see you with the results.

We’re accredited to see more than just adults, and we routinely perform Sleep Studies on those under the age of 18.

If you want your Sleep needs taken seriously, no matter what age you are, give us a call and we’ll put you in contact with our Adelaide Sleep Specialist.

© APSS 2014

High blood pressure and Sleep Apnoea : an often overlooked link

There are many reasons why someone’s blood pressure may be high, including genetic reasons, dietary reasons, and cardiac reasons. But did you know that one of the most important (and often missed) contributors is Obstructive Sleep Apnea?

The common link between Obstructive Sleep Apnoea (OSA) and Hypertension (high blood pressure) has been known for a long time, and yet we all still overlook this. There is significant literature regarding the link between the two.

More recently, an analysis of the heartBEAT study by Walia et al(1) showed an association between severe untreated Obstructive Sleep Apnea and resistant Hypertension. This was even whilst on blood pressure medications!

They found those with Severe OSA had a 400% higher risk of resistant hypertension. Medications often did not help, unless the OSA was treated.

The messages from this study are simple : Always think about OSA in those with hypertension, always exclude OSA first…

 

Key points :

•  OSA is a recognized major contributor to Hypertension
•  On more than 2 antihypertensives… think OSA!
•  Not responding to blood pressure medications… think OSA!
•  OSA increases risk of treatment-resistant hypertension by 4x

 

Our Adelaide sleep doctors can consult you, perform and report your sleep study, and your Adelaide sleep specialist will commence you on treatment. Give our Adelaide sleep clinic a call now.

1. Walia et al. J Clin Sleep Med. 2014;10:835-843

© APSS 2014

Sleepwalking, Sleeptalking, Parasomnias

Do you sleepwalk, sleeptalk, perhaps sleep-eat, or even hurt yourself or others in the night? This is usually indicative of a Parasomnia.

Undesirable and non-deliberate behaviours in the night whilst asleep (or at the transition in/out of sleep) are known as Parasomnias. These are exceedingly common in the younger age group, and can often be an indicator of other co-morbid sleep disorders in the older age group. More recently, they’ve attracted a lot of attention in the form of sleep-sex (sexsomnia!), sleep-related violence, and sleep-driving.

More commonly Parasomnias present as sleepwalking, sleeptalking, perhaps hitting out and hurting themselves or others.

In the past, these phenomena were attributed to behavioural or psychiatric disorders, but we now know that :

•  Parasomnias are a manifestation of many sleep disorders
•  Parasomnias are readily explainable
•  We can diagnose them easily
•  Parasomnias (both NREM and RBD) are treatable.

NREM Parasomnias are more common in the young, REM Parasomnias (REM Behaviour Disorder) more common in the older group and in those taking particular medications. Parasomnias also overlap with other conditions such as Narcolepsy. Treating Parasomnias without knowing their true triggers can make matters worse.

In our local Adelaide sleep clinic, we can consult you.

In our state-of-the-art Adelaide Sleep Laboratory, we can study these, assess the true triggers, and video-record any activity (something home sleep studies cannot do). We can also assess to see if these overlap with other conditions including Narcolepsy – this also can’t be done in the home.

If you suffer from a Parasomnia, contact us for an appointment.

© APSS 2014

Ocular manifestations of OSA

Did you know that OSA can manifest in your eyes?

Obstructive Sleep Apnoea (OSA) can contribute to many changes in your body. It can manifest with snoring, apneas, excessive daytime sleepiness, poor memory and concentration.

Did you know that OSA can manifest in eye disease? And we’re talking about more than just baggy eyes! These eye conditions include :

•  Glaucoma
•  Floppy Eyelid Syndrome
•  Papilloedema
•  Anterior Ischemic Optic Neuropathy
•  Retinal Vein Occlusion

Several studies have linked all the above eye conditions with untreated OSA. If picked up early by your optometrist / ophthalmologist / GP, your OSA could be diagnosed earlier and get treatment earlier.

OSA can cause fluctuations in oxygenation levels, blood pressure, and subsequently ocular perfusion pressures.

If you have one of these eye disorders, make sure that OSA is not contributing to it. Call our Sleep Clinic to organise a sleep study.

© APSS 2014

Atrial Fibrillation (AF) and OSA

Obstructive Sleep Apnoea is associated with diabetes, hypertension, erectile dysfunction, glaucoma, and of course heart disease. One of the more exciting and new links is between Atrial Fibrillation (AF) and OSA.

Both conditions are very common. AF is the most common cardiac arrhythmia in Australia, and OSA affects upto 24% of men and 9% of women. OSA combined with sleepiness (OSA Syndrome) occurs in 4% of men and 2% of women (1).

Patients with AF and those with OSA share similar demographic features – they are more likely to be male, hypertensive, of an older age, and have a higher body mass index. However, this link is much more than statistical chance.

Many studies have established that patients with severe OSA are significantly more likely to develop AF, increasing their risk by four times (2).

OSA decreases the likelihood of successful cardioversion (from medications or electrically) and increases the risk of AF returning. The recurrence rate of AF after cardioversion can be as high as 82% (3).

AF also recurs more often in those with OSA after radiofrequency catheter ablation (4).

According to Sleep Disorders Physician Dr Dien Dang, this is unsurprising considering the severe degree of haemodynamic compromise that occurs with OSA.

“OSA causes severe desaturations, cyclical hypoxaemia, and can structurally change your heart over time,” said Dr Dang, “Everyone who has ever had AF should consider a Sleep Study at Burnside Hospital.”

•  The OSA and AF population overlap considerably.
•  OSA can affect AF profoundly
•  Untreated OSA increases AF risk by 4x
•  Untreated OSA increases cardioversion failure by 4x

 

If you have Atrial Fibrillation, call us now for an in-Hospital Sleep Study.

1.  Young et al. NEJM 1993
2.  The Sleep Heart Health Study. AJRCCM 2006
3.  Kanagala et al. Circulation 2003
4.  Naruse Y et al. Heart Rhythm. 2012

© APSS 2014