Consequences of Obstructive Sleep Apnea: Cardiovascular Risk of Obstructive Sleep Apnea and Whether Continuous Positive Airway Pressure Reduces that Risk

To report the prevalence and characteristics of complementary medicine use and product utilization by Australians living with sleep disorders.

A cross-sectional study.

2025 adults representative of the Australian population by age, gender and state/territory of residence completed a survey consisting of 50 items including demographic, health services and complementary product/service utilization and health status items. The sociodemographic characteristics, prevalence and frequency of complementary medicine (CM) use, and out of pocket CM expenses were compared between those reporting a sleep disorder to those without a sleep disorder.

Of the 2019 respondents completing the online survey, 265 (13%) reported sleep disorders. Of these 265 respondents, the median age bracket was 40–50 years; 54.7% were females. The mean health-related quality of life score in this group was 44.8 ± 23.3; the group had a higher level of comorbid conditions compared to those without sleep disorders (p < 0.001). Two thirds (63.8%) of participants with a sleep disorder used complementary medicine compared to 52% of those without a sleep disorder (p < 0.001). Massage therapists and chiropractors were the main complementary medicine practitioners consulted by the group with sleep disorders; the average annual amount spent on visits to complementary medicine practitioners was significantly higher in this group (Australian dollars, AUD 160.0 ± 545.0) than in participants without sleep disorders (AUD 62.8 ± 251.0), p < 0.001. There were no significant differences in spending on complementary medicine products annually - those with a sleep disorder spent on average AUD 59.73 ± 266.38 annually, whilst those without spent AUD 62.8 ± 251.0 (p = 0.42). Of those with a sleep disorder, 97% reported consulting a general practitioner compared with 89.3% in the non-sleep disorders group (p < 0.001).

Both complementary medicine and conventional services/medicines use is more prevalent in Australians with sleep disorders compared to those not reporting a sleep disorder. This raises a number of clinical and safety considerations including accommodating patient preferences.

To determine prevalence of comorbid undiagnosed sleep disordered breathing (SDB) in chronic insomnia patients, using two complementary methods, one standard and one novel.

Using prospective design, adult patients diagnosed with chronic insomnia, treated with prescription pharmacological agents for >3 months without prior objective sleep evaluation or diagnosis of SDB were invited to participate. All patients recorded their sleep for two consecutive nights using level 3 home-sleep-apnea-test (HSAT) device to derive Respiratory Event Index (REI) for OSA diagnosis. The electrocardiogram-signal (ECG) recorded by the same device was analyzed using FDA cleared medical software, Cardiopulmonary Coupling (CPC) to quantify sleep time and identify sleep-quality and pathology.

Of 110 chronic insomnia patients who volunteered between May 2017 and June 2018, 88% were women. Prevalence of moderate-severe SDB (REI > 15) was 25% based on REI-scoring. Surrogate markers of moderate-severe SDB detected by the novel method identified prevalence of 33%, with negative predictive value 96%, reclassifying 10 individuals that HSAT diagnosed with mild SDB with more advanced disease state. Agreement between the methods is 88%.

High prevalence and overlap in symptoms between insomnia and SDB warrants objective testing when evaluating sleep complaints before therapy is initiated. Diagnostic caution is even more importantly warranted for female patients presenting insomnia sleep complaints, as SDB may not be initially considered as a biological symptom driver. CPC-analysis can complement standard HSAT or serve as a standalone option to evaluate sleep complaints in individuals presenting insomnia symptoms before therapy is initiated.

Pilot study: Co-occurrence of Insomnia and Sleep Disordered Breathing (SDB) symptoms: Prospective study focusing on chronic insomnia patients treated with pharmacological agents. Approved by the Bioethics Committee on March 7^th, 2017.

VSNb: 17- 047- S1/ ST - GRA - 17029 – PDX – SH http://vsn.is/is/content/17-047

Sleep disordered breathing (SDB) comprises a spectrum of disorders, ranging from simple snoring to severe obstructive sleep apnoea (OSA), with a significant burden to health care systems in high income countries. If left untreated, OSA has significant cumulative, long-term health consequences. In the 1990s drug induced sedation endoscopy (DISE) has been developed to become a primary tool in the diagnosis and management of OSA. It allows meticulous endoscopic evaluation of the airway and identifies areas of collapse, thereby informing both on the selection of surgical techniques, where efficacy depends entirely on success at relieving obstruction at a certain level and on the usefulness of conservative measures, such as mandibular advancement splints. This article provides a review of the literature on DISE, covering different grading systems and techniques, explaining different rationales and discussing controversies.