What is Sleep Apnoea and would early treatment reduce road deaths?

Sleep related difficulties affect a numerous amount people, one of the more
prominent sleep disorders, Sleep Apnoea Syndrome, a clinical disorder characterized
by abnormal rhythm of breathing whilst asleep. One may suffer from prolonged
snoring habits, yet this may be an indication of this particular disorder. Although, it
may be a progressive disorder which unless treated with early treatment, may result
in sleep-deprived driving. An impaired cognitive ability to drive thus leads to a fatal
car crash. The prevalence of sleep apnoea has resulted in 250,000 drivers falling
asleep behind the wheel 1. In relation to road deaths, the National Highway Traffic
Administration has reported that ‘Drowsy Driving is a factor in more than 100,000
crashes’1, amongst which 1550 constitute do death. These figures may sound
alarming, although other agencies predict them at a much higher measure. The
condition may well be prevalent in the course of many years but daytime sleepiness
and fatigue as well as sleep disturbances are likely indicators of sleep apnoea.
Henceforward, insomnia, irritability, mood swings, anxiety and depression are also
the underlining symptoms of sleep apnoea. The prognosis is that one who bears this
condition has a much increased probability of involvement in road accident. In such
circumstances one’s health may be at an increased risk.

Classification

Sleep apnoea is categorized into three; CSA (Central), OSA (Obstructive) and the
latter being a combination of both (Central and Obstructive), all three constituting to
0.4%, 84% and 15% of incidents respectively2. The most conspicuous of the three,
Obstructive Sleep Apnoea, is whereby the throat of the human body is obstructed by
the collapsible walls of the soft tissue due to the lack of muscle tone. It typifies
repetitive pauses, around 20-40 seconds, typically resulting in a reduction in blood
oxygen. Although sleep apnoea is experienced by some individuals for a minute
period of time, upper respiratory infections can also be a counterpart of sleep
apnoea. Such Infections as to; tonsillitis, nasal congestion, swelling of the throat can
contribute to sleep apnoea in the very minute cases. Although, this may not be as
important, chronic sleep apnoea must be treated in advance to minimise any added
complications such as hypoxemia (low blood oxygen). The typical symptoms of OSA
are; hypersomnolence (sleepiness), enlarged tonsils and tongue, micrognathia
(undersized jaw), educational difficulties and BMW > 30. Conversely, men who are
broad and have a large physic, tend to have a enlarged neck as such, a possible
indication of OSA. This is primarily due to the fact that structural features around the
soft tissue of the airway, potentially can decrease the muscle tone thereby giving rise
to further/increased chance of OSA. Although vary rare, the correlation of genetics
proliferating the chances of OSA further has a input, thus if a family of previous
history entail this condition then the a member is also as likely to develop the
disorder. Old age as well as muscular and neurological difficulties too have a
possibility to reduce the functioning of the airways. Sedatives, drugs, alcohol and
chemicals can all exacerbate OSA.

In contrast, Central Sleep Apnea (CSA) tends to occur as the neurological

mechanism of the brains respiratory system do not promptly react in response and
fail to maintain and even respiratory balance. The brains respiratory centre is
decisive in ensuring that the smallest drop in oxygen does not impede the ability to
breathe. Due to this neurological dysfunction it results failure in circulation and an
increase in CO2 concentration (hypercapnia) in the blood. This in effect causes a
reflex action and a sudden arousal from the individual to replenish oxygen content.
Chemoreceptors present in the bloodstream transmit nerve impulses to brain in order
for it to dilate the larynx so that vocal chords open facilitating O2 to enter. This is may
be severe, as all physiological aspects of the body require O2, which could
potentially be lethal if cells do not gain access to it. Lack of oxygen can be clearly
notable as coloration of skin will show (cyanosis). Amongst individuals who suffer
form CHD may also experience arrhythmia’s, angina and in worst cases a myocardial
infarction. In other such cases, the inability to eradicate the CO2, may in several
years alter the pH of blood, which essentially results in metabolic acidosis (kidney
malfunction). The latter of, Mixed Sleep Apnea, comprises both OSA and CSA. As
one occurs the other may not, although this is a field of active research it rather
depicts the symptoms same as that of OSA and CSA.

Sleep Apnea and Driving?

Sleep deprivation as a consequence of sleep apnea has recently seen to influence

impaired ability to drive. Statistics conclude that 41% of drivers have at once fallen
behind the wheel with over 56,000 cases of sleep-related road accidents per year
amongst which 40,000 cases constitute to injuries and 550 deaths5. Sleep
deprivation has further been undermined, as to having ‘similar effects to that of a few
cocktails’ with a ‘blood-alcohol level of 0.5%’5.Recent studies have conveyed that
‘nigh time sleeping disorders’ associated with OSA are ‘twice as likely’ to be involved
in car collision4. Dr. John Fleetham commented that ‘patients may not be aware’ of
the potential hazards resulting from sleep apnea. Amongst the many symptoms, the
consequences vary:

Slower reaction time: EDS (excessive daytime sleep) slowing your reflex actions.

Concentration levels fall: attention duration decreases. Irritability, Anxiety and unable
to focus on key tasks. At times poor hand-eye coordination.

Most simply, sleep apnoea is capable of resulting in a multitude of deprived sleep,

oxygen depletion that subsequently may lead to hypertension. Equally
cardiovascular problems, memory failure and mood swings are added difficulties that
could potentially increase the risk of car incidents.
1 - http://www.shiftworkdisorder.com/about

2 - http://www.journalsleep.org/ViewAbstract.aspx?pid=26630

3 - http://healthkut.com/blog/wp-content/uploads/2010/02/sleep-apnoea-
syndrome.jpg

4 - http://www.sciencedaily.com/releases/2007/05/070520130053.htm

5 - http://www.serenocenter.com/blog/post/2011/01/13/driving-drowsy-as-bad-as-
drunk/

http://www.helpguide.org/life/sleep_apnea.htm

http://www.medicinenet.com/sleep_apnea/article.htm

http://www.sleepfoundation.org/article/sleep-related-problems/obstructive-sleep-
apnea-and-sleep

http://www.osarx.com/what_we_treat/osa_sleep_apnea/

http://www.suite101.com/content/sleep-apnea-and-drowsy-driving-a45719

http://sleep.lovetoknow.com/Sleep_Deprivation_Symptoms - Narcolepsy

Data

http://ajrccm.atsjournals.org/cgi/content/full/158/1/18 - journal
http://science.education.nih.gov/supplements/nih3/sleep/guide/info-sleep.htm - bar
chart
National Sleep Foundation
http://www.talkaboutsleep.com/sleep-disorders/archives/Snoring_apnea_intro.htm
Obesity hypoventilation syndrome – pickwickien syndrome
Haemodialysis
http://www.sciencedaily.com/releases/2008/02/080218214401.htm