sleep apnea

  • Sleep Apnea Treatment Linked with Lower Health Care Costs

    Original Post | SleepReviewMagazine, Published on October 15, 2019

    Piggy Bank showing cost savings from treatment of sleep apnea

    Treating patients with moderate or severe obstructive sleep apnea with positive airway pressure (PAP) therapy is associated with reduced acute care visits and health care expenditures, according to a recent study.

    Every one-hour increase in PAP usage per night was associated with an 8% decrease in inpatient visits (rate ratio 0.92) and a 4% decrease in overall acute care visits (RR 0.96). PAP adherence also was associated with a significantly lower number of emergency department visits and inpatient stays, and increasing PAP usage was associated with a lower likelihood of having positive costs from these visits. Among patients with emergency department costs, PAP adherence was associated with 27% lower costs.

    “While it’s not surprising that treatment of moderate or severe sleep apnea is good for overall health, the fact that PAP treatment in a relatively short time frame was associated with an impact of this significance was unexpected,” says lead author Douglas B. Kirsch, MD, American Academy of Sleep Medicine president, medical director of sleep medicine at Atrium Health in Charlotte, NC, and clinical professor in the Department of Medicine at UNC School of Medicine, in a release. “In addition, while many older research trials suggested patients were not often adherent to PAP therapy, this study of more than 1,000 patients suggests that with appropriate education and support, a significant majority of patients are likely to use PAP therapy in an effective manner.”

    The study was published in the Sept 15 issue of the Journal of Clinical Sleep Medicine.

    The authors conducted a retrospective cohort study of adult patients who initiated PAP therapy after a diagnosis of moderate or severe sleep apnea at a large integrated health system between 2014-2016. The study consisted of 1,098 patients (average age 55.7 years, 66.3% male) who had at least 18 months of available data after PAP therapy was initiated. Treatment adherence was defined as using PAP more than four hours per night for at least 70 percent of the studied nights.

    Results show that 60% of the study population was adherent to PAP therapy, and the overall average percentage of nights with PAP usage of more than four hours was nearly 70%. The average use on nights when PAP was used was 6.4 hours per night, and the average use on all nights was 5.3 hours.

    “Patients, clinicians and health systems should recognize that effective treatment of sleep apnea is valuable in both an individual’s health and as a mechanism to keep overall medical costs lower for the patient and the health system,” says Kirsch. “This study suggests that a significant majority of patients not only tolerate but are adherent to therapy over an 18-month time frame when given effective education and support.”

  • Sleep-Disordered Breathing Tied to Accelerated Aging

    SAN ANTONIO — Sleep-disordered breathing (SDB), and the disruption in nightly sleep it causes, speeds up the aging process, according to preliminary research.

    SDB is a common disorder that results in oxidative stress and inflammation and is associated with several age-related health disorders. However, it hasn’t been well studied with respect to epigenetic aging.

    “To our knowledge, this study is the first empirical study that has linked sleep-disordered breathing with epigenetic age acceleration,” Xiaoyu Li, ScD, of Brigham and Women’s Hospital and Harvard Medical School in Boston, Massachusetts, told Medscape Medical News.

    The study was presented here at SLEEP 2019: 33rd Annual Meeting of the Associated Professional Sleep Societies.

    Elderly Looking Woman

    Women are particularly vulnerable. 

    The study included 622 adults (mean age 69 years, 53% women) from the Multi-Ethnic Study of Atherosclerosis (MESA). All participants underwent polysomnography; DNA methylation, a marker for epigenetic age acceleration, was measured in blood samples.

    Age acceleration measures were calculated as residuals from the regression of each epigenetic age on chronologic age. The association of each SDB trait with age acceleration was estimated using linear regression, controlling for sociodemographics, health behaviors, body mass index, and study site.

    Increasing SDB severity and sleep disruption were associated with epigenetic age acceleration, independent of measured confounders, Li reported.

     

  • Impulsive Behavior in Children Linked to Sleep and Screen Time, Study Says

    Children and youth who do not sleep enough and use screens more than recommended are more likely to act impulsively, recent research published in Pediatrics suggests.

    Impulsive Sleep Deprived Child Jumping on Bed

    The findings come from the Healthy Active Living and Obesity Research Group (HALO) at the CHEO Research Institute in Ottawa.

    “Impulsive behavior is associated with numerous mental health and addiction problems, including eating disorders, behavioral addictions and substance abuse,” Michelle Guerrero, PhD, lead author and postdoctoral fellow at the CHEO Research Institute and the University of Ottawa, says in a release.

    “This study shows the importance of especially paying attention to sleep and recreational screen time, and reinforces the Canadian 24-Hour Movement Guidelines for Children and Youth. When kids follow these recommendations, they are more likely to make better decisions and act less rashly than those who do not meet the guidelines.”

    The Canadian 24-Hour Movement Guidelines for Children and Youth recommends 9-11 hours of sleep per night and no more than 2 hours of recreational screen time per day.

    The paper analyzed data for 4,524 children from the first set of data of a large longitudinal population study called the Adolescent Brain Cognitive Development (ABCD) Study, which will follow participants for 10 years. In addition to sleep and screen time, the ABCD study also captures data related to physical activity. Physical activity is a third pillar of the Canadian 24-Hour Movement Guidelines, which recommend at least 60 minutes of moderate to vigorous physical activity daily.

    The ABCD study allowed Guerrero and her team to look at the three pillars of the movement guidelines against eight measures of impulsivity, such as one’s tendency to seek out thrilling experiences, to set desired goals, to respond sensitively to rewarding or unpleasant stimuli, and to act rashly in negative and positive moods. The study results suggest that meeting all three pillars of the movement guidelines was associated with more favorable outcomes on five of the eight dimensions.

    Guerrero and her team say that studies using feedback devices to measure the movement behaviors in future research will help further our understanding of how physical activity, screen time, and sleep relate to children’s impulsivity.