Up to one-third of crashes of large trucks are attributable to sleepiness, and large truck crashes result in more than 4,000 deaths annually. For each occupant of a truck who is killed, 6 to 7 occupants of other vehicles are killed.
Obstructive sleep apnea (OSA) is a sleep-related breathing disorder that is characterized by repetitive episodes of complete or partial upper airway obstruction during sleep.1 OSA is common among adults,2,3 and it is particularly common in commercial operators.4–8 Untreated OSA leads to increased morbidity and mortality, as well as high costs related to crashes, health care use, absenteeism, and lost productivity.9–11 A systematic review and meta-analysis commissioned by the Federal Motor Carrier Safety Administration (FMCSA) shows that drivers with OSA have a crash risk that is between 21% and 489% higher than comparable drivers without OSA.12 A 2013 meta-analysis of more than 25,000 individuals who were enrolled in 12 studies shows that OSA was associated with an increased risk for cardiovascular disease (relative risk: 1.79), fatal and nonfatal stroke (relative risk: 2.15), and death from all causes (relative risk: 1.92).13Obstructive sleep apnea screening, diagnosis, and treatment in the transportation industry – https://jcsm.aasm.org/doi/10.5664/jcsm.9672
“Most clinicians, and even experts in the sleep apnea world, have not typically focused on fat in the tongue for treating sleep apnea,” said Richard Schwab, MD, chief of Sleep Medicine. “Now that we know tongue fat is a risk factor and that sleep apnea improves when tongue fat is reduced, we have established a unique therapeutic target that we’ve never had before.”
From the research article abstract:
Weight loss reduced volumes of several UA soft tissues in persons with obesity and OSA. Improved AHI with weight loss was mediated by reductions in tongue fat. New treatments that reduce tongue fat should be considered for patients with OSA.
- Stephen H. Wang, Brendan T Keenan, Andrew Wiemken, Yinyin Zang, Bethany Staley, David B. Sarwer, Drew A. Torigian, Noel Williams, Allan I Pack, Richard J Schwab. Effect of Weight Loss on Upper Airway Anatomy and the Apnea Hypopnea Index: The Importance of Tongue Fat. American Journal of Respiratory and Critical Care Medicine, 2020; DOI: 10.1164/rccm.201903-0692OC
Wait for it. A plethora of diet and weight loss books for your tongue.
This new study found that, in addition to how many breathing interruptions occur, how long each one lasts is also important. Patients with the shortest apneas were 31 percent more likely to die during the study’s decade of follow-up with participants. This held true for both male and female participants.
CONCLUSIONS – OSA is independently associated with an increased risk of diabetes, whereas insulin-treated diabetes is independently associated with a higher risk of OSA, particularly in women. Clinical awareness of this bidirectional association may improve prevention and treatment of both diseases. Future research aimed at elucidating the mechanisms that underlie each association may identify novel intervention targets.
Access the study here.
In a five-year study of nearly 11,000 people, those with obstructive sleep apnea had a higher risk of sudden cardiac death. At greatest risk were those aged 60 and older with moderate to severe apnea (20 episodes an hour).
When their oxygen saturation levels dipped below 78 percent — preventing air from flowing into the lungs — their risk increased by 80 percent.
Memo to Underwriters:
In case anyone asks why we are so harsh on untreated OSA quote this study.
Article link here.
During an average follow-up of 5.3 years, 142 patients had resuscitated or fatal SCD (annual rate 0.27%). In multivariate analysis, independent risk factors for SCD were age, hypertension, coronary artery disease, cardiomyopathy or heart failure, ventricular ectopy or nonsustained ventricular tachycardia, and lowest nocturnal O2sat (per 10% decrease, hazard ratio [HR]: 1.14; p = 0.029). SCD was best predicted by age >60 years (HR: 5.53), apnea-hypopnea index >20 (HR: 1.60), mean nocturnal O2sat <93% (HR: 2.93), and lowest nocturnal O2sat <78% (HR: 2.60; all p < 0.0001).
In a population of 10,701 adults referred for polysomnography, OSA predicted incident SCD, and the magnitude of risk was predicted by multiple parameters characterizing OSA severity. Nocturnal hypoxemia, an important pathophysiological feature of OSA, strongly predicted SCD independently of well-established risk factors. These findings implicate OSA, a prevalent condition, as a novel risk factor for SCD.
Sleep apnea, left untreated for even a few days, can increase blood sugar and fat levels, stress hormones and blood pressure, according to a new study of sleeping subjects. A report of the study’s findings, published in the August issue of The Journal of Clinical Endocrinology & Metabolism, adds further support for the consistent use of continuous positive airway pressure (CPAP), a machine that increases air pressure in the throat to keep the airway open during sleep.
Jun emphasized that the study was limited by studying people with severe OSA and obesity, thus limiting the ability to apply the findings to all OSA patients. The researchers also did not compare CPAP use to a sham CPAP control group to exclude a potential placebo effect
Researchers in Connecticut have found that obstructive sleep apnea (OSA) in patients with atrial fibrillation (AF) appears to be an independent predictor of stroke.
OSA is independently associated with DN in type 2 diabetes. eGFR declined faster in patients with OSA. Nitrosative stress may provide a pathogenetic link between OSA and DN. Interventional studies assessing the impact of OSA treatment on DN are needed.