Obesity is one of the most critical health problems currently facing our planet. The prevalence of overweight and obesity has continued to rise in recent decades, with nearly one in five children and more than one in three adults in the U.S. now classified as obese (http://www.cdc.gov/obesity/data). The extraordinary ramifications of this epidemic on physical health, emotional wellbeing, and the economy cannot be overstated. Medical costs associated with the current obesity epidemic have been estimated to be in the hundreds of billions of dollars annually. As the population of our nation ages in the midst of a struggling economy and a healthcare system that is in flux, this upward trend must be reversed rapidly and dramatically if we are to avert catastrophic consequences.
Driving Impairment and Accident Risk in Sleep Apnea: We Need Better Assessment Tools
Obstructive sleep apnea (OSA) is strongly associated with neurobehavioral impairment and increased motor vehicle accident (MVA) risk resulting in an estimated 1400 road fatalities and a cost of $15.9 billion annually in the United States alone. Despite these alarming figures, the elevated MVA risk might only relate to a subset of the OSA patient population, while a large proportion of patients show minimal or no driving impairment and present no relative risk on the road. At present, assessing an OSA patient’s MVA risk, and their eligibility to hold an unrestricted driver’s licence, is challenging. Current clinical metrics of OSA severity and daytime sleepiness are limited in their ability to identify at-risk patients. There is a need for novel assessment tools that may better reflect the risk of neurobehavioral impairment and MVA in individuals, allowing for targeted prioritisation of clinical resources and ultimately, improving traffic safety.
The snore is a breathing sound that originates during sleep, either nocturnal or diurnal. Many procedures have been used for its analysis, from simple interrogation, going through acoustic methods that have been developed thanks to the advance of biomedical techniques in recent years. So far a procedure homologated by different laboratories for its study doesn’t exist. The present editorial describes the current state of the art in the snoring analysis procedures.
Opioid Induced Sleep Disordered Breathing in Sickle Cell Patient
Chronic opioid use is a risk factor for sleep disordered breathing (SDB) like obstructive sleep apnea (OSA), Biot’s or ataxic breathing, central sleep apnea and sleep related hypoventilation. Withdrawal of opioids may be the optimal management but it is not always feasible. Continuous positive airway pressure (CPAP) therapy, which is effective treatment for OSA, may not resolve central events. Opioid induced sleep disordered breathing has been described mostly in patients with chronic back pain on narcotics. We present a case of sickle cell disease who is a 37 year old male on short and long acting Morphine presenting with excessive daytime sleepiness, fatigue and memory loss. Baseline nocturnal polysomnography (NPSG) showed central sleep apnea (Biot’s breathing) with AHI of 27. After initial failure of CPAP, ASV at IPAPmax/ EPAPmin (inspiratory and expiratory positive airway pressures) of 25/7 cm of H2O with a pressure support setting of 0-15 and auto back-up rate was applied with complete resolution of Biot’s breathing and symptoms. This case highlights the increased risk of central sleep apnea induced by opioids in a population with improving life expectancy and chronic use of narcotics. It also adds to the small but growing body of evidence suggesting the beneficial role of ASV in opioid induced sleep disordered breathing where narcotics /opioids cannot be discontinued.