News

2017 Nobel prize winners : the first to be awarded in the field of Sleep Medicine!

Congratulations to the 2017 Nobel Prize Winners in Physiology or Medicine : Jeffrey C. Hall, Michael Rosbash and Michael W. Young. Their work was in discovering molecular mechanisms crucial to control of the circadian rhythm (body clock).

Hall, Rosbash and Young used fruit flies as specimens, isolating a gene that controlled the fly’s daily biological rhythm. From their work, this has led to a much better understanding of biological rhythms in other species… including humans.

Circadian Rhythm Disturbances (CRD) comprise a large proportion of Sleep Medicine, and accounts for a notable number of sleep disorders – particularly in childhood an adolescents.

At Adelaide Sleep, we loudly congratulate Hall Rosbash and Young for their ever-enduring work, and amazing accomplishments! Thankyou!

© APSS 2017

Diaphragm pacing for Central Sleep Apnoea

Treatments for Central Sleep Apnoea (CSA) are limited – that’s why we’re excited about the potential for new treatments such as Transvenous Neurostimulation… essentially, pacing the diaphragm to help you breathe.

Obstructive Sleep Apnoea (OSA) is the upper-airway closure resulting in a drop in oxygenation (oxygen saturations). Central Sleep Apnoea (CSA) is when there is a lack of air flow (breathing) but because of no effort. IE, the muscles moving your chest wall and diaphragm do not proceed as one would expect.

CSA can occur in many circumstances, including :

  • Heart failure ** (the most common cause)
  • Strokes
  • Opioid use (methadone, morphine)
  • Myotonic dystrophy
  • Renal failure
  • High altitude.

Whilst OSA is almost always treated with CPAP, the success in treating CSA with CPAP is limited. With the departure of ASV as an option in heart failure patients (Serve-HF trial results), diaphragmatic pacing comes at an opportune time.

Costanzo et al (1) looked at those with almost all kinds of CSA (but mainly heart failure), offering them diaphragmatic pacing vs. no-pacing.

At 6 months, more than half (51%) of those with pacing managed to reduce their CSA events by 50%, compared to 11% in those without pacing. There was also an improvement in the Quality of Life Scores, their sleepiness (ESS), and oxygenation.

These very promising results will hopefully one day allow us to provide an alternative treatment for those with CSA.

If you have a Sleep Disorder and would like to see one of our Medical Specialists, give us a call for an appointment now.

1. Costanzo et al. Lancet 2016; 388: 974–82

© APSS 2017

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

OSA and Congenital long QT syndrome

We’ve long known OSA has been associated with a higher prevalence of AF, and worsening AF control. We now know it’s also associated with many Cardiac Arrhythmias, including deadly Congenital long QT syndrome (LQTS).

LQTS is characterised by prolonged ventricular repolarization and increased risk of torsades de pointes. Those with LQTS usually present with seizures, syncope, even sudden cardiac death (SCD).

Shamsuzzaman (1) looked at patients with LQTS and performed sleep studies in them, and (not un-expectedly) they concluded that OSA in these patients were asscoiated with a worsening of their LQTS.

•  OSA worsens QTc
•  Worsening QTc is a biomarker for sudden cardiac death
•  This worsening in their QTc was during wake, as well as sleep!

OSA has a profound impact on your Cardiac burden.

Adelaide’s resident Specialist Cardiologists at the Centre for Heart Rhythm Disorders (2) agree that it’s time we all acknowledged OSA’s impact on Cardiac Arrhythmias.

If you have a cardiac problem, whether it be a rhythm problem or otherwise, see us now.

1. Shamsuzzaman et al. Sleep 2015.
2. Dr Rajeev Pathak, Dr Rajiv Mahajan, Dr Dennis Lau, Prof Prashanthan Sanders. Sleep 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