Mayo Clinic Physicians Report Findings From Research On Sleep Disorders

Main Category: Sleep / Sleep Disorders / Insomnia
Also Included In: Respiratory / Asthma;  Cardiovascular / Cardiology;  Conferences
Article Date: 25 Oct 2007 - 0:00 PST

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Mayo Clinic physicians offered updates about diagnosing and treating patients with a variety of sleep disorders, including obstructive sleep apnea and sleep behavior disorders, at CHEST 2007, the annual meeting of the American College of Chest Physicians in Chicago on Oct. 20-25. The following are brief summaries of select presentations.

More than 12 million people in the United States have obstructive sleep apnea, a potentially serious disorder in which breathing repeatedly stops and starts during sleep when the throat muscles relax

People with the rapid eye movement (REM) sleep disorder known as REM behavior disorder (RBD) sometimes act out their dreams by yelling or moving violently during REM sleep. A rare condition, RBD affects between 0.4 percent and 0.5 percent of the population.

Each year, physicians at Mayo Clinic's campuses in Arizona, Florida and Minnesota treat thousands of patients who have sleep disorders. For more information on the treatment of sleep disorders at Mayo Clinic, visit http://www.mayoclinic.org/sleep-disorders.

Obstructive Sleep Apnea Linked with Cardiovascular Problems

Daytime fatigue, sleepiness and sleep-deprived bed partners are several symptoms commonly observed in patients with obstructive sleep apnea. More serious, however, are the cardiovascular problems associated with this sleep disorder.

Mayo Clinic pulmonologist Kannan Ramar, M.B.B.S., M.D., describes how physiological changes that occur during obstructive sleep apnea episodes affect the cardiovascular system. Sudden drops in blood-oxygen levels increase blood pressure and strain the cardiovascular system. About half of those with sleep apnea develop high blood pressure (hypertension), which raises their risk of heart failure and stroke. Obstructive sleep apnea may be associated with strokes, coronary artery disease and metabolic problems such as diabetes. Repeated multiple episodes of low blood oxygen (hypoxia or hypoxemia) can also lead to sudden death from a cardiac problem in people with underlying heart disease. Also, there is a strong association between obstructive sleep apnea and dangerous heart rhythm changes (dysrhythmias).

"Mounting data suggests that obstructive sleep apnea contributes to cardiovascular disease, independent of obesity and other cardiovascular risk factors," explains Dr. Ramar. "Considering that obstructive sleep apnea is treatable, establishing causality with other cardiovascular disorders has far-reaching implications. Long-term studies are needed to assess the impact that treatment with continuous positive airway pressure (CPAP)and other treatment modalities has upon cardiovascular outcomes."

CPAP therapy is a preferred method of treating sleep apnea. A machine delivers air pressure through a mask placed over the nose during sleep. CPAP elevates the air pressure in the upper airway passages slightly to keep these passages open, and to prevent apnea and snoring.

Consensus needed on treatment options for obstructive sleep apnea

Mayo Clinic pulmonologist Peter Gay, M.D., discusses trends in the care of people with obstructive sleep apnea. Dr. Gay notes that while experts now universally accept the need to consider this condition as a chronic disease, more research and discussion is needed to establish consensus about the best and most practical way to manage the long-term care for people with this disorder.

"Given that the use of CPAP therapy can be challenging for a large minority of patients (up to 30 percent to 40 percent), we need research to address several questions related to how we may better optimize adherence to therapy," explains Dr. Gay. "Asking 'How important is the immediate or near-immediate introduction of continuous positive airway pressure (CPAP) therapy in these patients?' and 'How early and frequently should these patients be seen in follow-up?' is important. Answering these questions will help us refine our chronic care plans and give further insight into how we may reduce several conditions such as cardiovascular disease, mood disorders, and accidents, all of which are associated with sleep apnea."

Rare Sleep Disorder Marked by Excessive and Sometimes Violent Movements

People with RBD might yell or move excessively during sleep. According to Mayo pulmonologist John Park, M.D., these episodes occur when the muscle paralysis normally present during rapid eye movement (REM) sleep is incomplete or absent, allowing the person to physically act out his or her dreams.

"This condition is usually brought to our attention when a bed partner reports being struck or physically harmed or observes the patient harming himself or herself in the midst of a dream enactment," says Dr. Park.

Dr. Park notes that while the symptoms of RBD can be alarming, the disorder can be treated. Sometimes the behavior is related to untreated sleep apnea and the condition resolves with regular sleep apnea treatment. For RBD where the cause is unknown (idiopathic RBD), treatment usually includes making the sleep environment safer, and use of medications, depending on the severity of episodes.

Seeking treatment for RBD also allows the patient to be monitored for signs of neurological disorders such as Parkinson's disease and other forms of dementia, which some patients with RBD have or develop later.

To obtain the latest news releases from Mayo Clinic, go to http://www.mayoclinic.org/news. MayoClinic.com (http://www.mayoclinic.com) is available as a resource for your health stories. For more on Mayo Clinic research, go to http://www.mayo.edu.

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