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Thoracic Medicine

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Sleep Medicine

Latest News

TSGQ registered nurse and polysomnographic technician Travis Bell joined 612 ABC radio presenter Kelly Higgins-Devine to discuss sleep disorders on 2nd February 2015.

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Scientists have found that that activation of cholinergic neurons - those that release the neurotransmitter acetylcholine -- in two brain stem structures can induce REM sleep in an animal model. Better understanding of mechanisms that control different sleep states is essential to improved treatment of sleep disorders.

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Going to bed early could help individuals avoid repetitive negative thinking, according to a recent study. According to the authors, repetitive negative thinking is "defined as an abstract, perseverative, negative focus on one's problems and experiences that is difficult to control."

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In a recent US study results indicated that poor sleep may be an early warning sign for addictive and “regretful” behaviour; such as alcohol problems, illicit drug abuse and sexual behaviour. US researchers reviewed the sleep patterns of 6500 adolescents in combination with drug and alcohol habits, between 1994 and 2002.

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Scientists at the Medical College of Wisconsin (MCW) have discovered a link between sleep loss and cell injury. Results of a new study find sleep deprivation causes the damage to cells, especially in the liver, lung, and small intestine. Recovery sleep following deprivation heals the damage.

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New research confirms that sleep disturbances are linked to pain and depression, but not disability, among patients with osteoarthritis (OA).  Results from a new study found that poor sleep increases depression and disability, but does not worsen pain over time.

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Sleep and Stroke



 

 

 

The relationship between sleep disorders and stroke is important. Strokes can lead to sleep problems, and some sleep problems can increase the risk of stroke.

Stroke is the second leading cause of death worldwide. Although scientists have uncovered several risk factors for stroke, such as age, diabetes, high blood pressure and atrial fibrillation there are still many cases in which the cause or contributing factors remain unknown.

Why obstructive sleep apnoea (osa) can cause stroketsgq_head_strokesml

 

When you have an apnoea there can be a dramatic drop in blood oxygen (hypoxia). This increases heart rate and blood pressure variability which increases the risk of hypertension and heart arrhythmias.

In addition there is a reduction in blood flow to the brain, further damage to blood vessels, acceleration of atherosclerosis, and increased clotting risk. OSA ultimately increases the risk of fatal and non-fatal stroke between 3-10 fold.

Obstructive sleep apnoea (OSA) is associated with an increased risk of stroke in middle-aged and older adults, especially men, according to new results from a landmark study supported by the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health. Researchers from the Sleep Heart Health Study (SHHS) report that the risk of stroke appears in men with mild OSA, and that this risk rises significantly with the severity of OSA. This risk is independent of other risk factors such as weight, high blood pressure, race, smoking, and diabetes.

Conducted in nine medical centres across the United States, the SHHS is the largest and most comprehensive prospective, multi-centre study on the risk of cardiovascular disease and other conditions related to OSA. In the latest report, researchers studied stroke risk in 5,422 participants aged 40 years and older without a history of stroke.

Researchers followed the participants for an average of about nine years. They report that during the study, 193 participants had a stroke — 85 men (of 2,462 men enrolled) and 108 women (out of 2,960 enrolled).

After adjusting for several cardiovascular risk factors, the researchers found that the effect of OSA on stroke risk was stronger in men than in women. In men, a progressive increase in stroke risk was observed as OSA severity increased from mild to severe levels.
"Our findings provide compelling evidence that OSA is a risk factor for stroke, especially in men". "Overall, the increased risk of stroke in men with OSA is comparable to removing 10 years from a man’s age. Importantly, we found that increased stroke risk in men occurs even with relatively mild levels of sleep apnoea".

"Research on the effects of sleep apnoea not only increases our understanding of how lapses of breathing during sleep affects our health and well being, but it can also provide important insight into how cardiovascular problems such as stroke and high blood pressure develop" noted Michael Twery, Director of the NIH National Centre on Sleep Disorders Research in the USA.

There is now abundant evidence that OSA is associated with cardiovascular risk factors and diseases. Research is currently underway to determine how successfully treating OSA can lower a person’s risk of this leading killer.

Hypertension 

Successful treatment of hypertension is much less likely if OSA remains untreated.  This further accelerates the risk of vascular disease, including repeat strokes.

It is important for your doctor to consider OSA if you have ‘resistant’ hypertension.

 

 

 

 

what if i have already had a stroke?

In OSA there is night-time hypoxia, lowered cardiac output and reduced cerebral blood flow. This contributes “further noxious stimuli” to a brain already damaged by stroke, which can then become susceptible to further strokes.

Recent studies also found that approximately 70% of stroke patients have OSA, more than 10 times higher than in the otherwise healthy population. Researchers also discovered that the severity of OSA has a direct relationship with functional impairment, and this relationship persisted even after the analysis was controlled for age, weight, and type and location of stroke.

Stroke patients with untreated OSA also have a 40% longer rehabilitation period in hospital. In addition once they left hospital they were still more impaired than the other group. Furthermore, the functional impairment can be relatively refractory to therapy.

Currently, assessment and treatment of OSA are often not part of standard therapy for stroke patients. Based upon this new research Sleep Physicians recommend this be included in the rehabilitation period assessment.

For more information on Stroke click here.

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