scholarly journals Reduction in motor vehicle collisions following treatment of sleep apnoea with nasal CPAP

Thorax ◽  
2001 ◽  
Vol 56 (7) ◽  
pp. 508-512 ◽  
Author(s):  
C F P George
Keyword(s):  
Positive Airway Pressure ◽  
Motor Vehicle ◽  
Sleep Apnoea ◽  
Control Group ◽  
Motor Vehicle Collisions ◽  
Vehicle Collisions ◽  
Obstructive Sleep ◽  
Before And After ◽  
Time Frames ◽  
Over Time

BACKGROUNDPatients with untreated obstructive sleep apnoea (OSA) have increased motor vehicle collisions (MVCs). When successfully treated, they report improved driving and fewer mishaps, but there are few objective data to confirm this. A study was therefore undertaken to examine actual MVC data in a large group of patients with OSA before and after treatment with continuous positive airway pressure (CPAP) compared with a control group matched for age, sex, and type of driver's licence (commercial or non-commercial).METHODSTwo hundred and ten patients of mean (SD) age 52 (11) years, body mass index (BMI) 35.5 (10) kg/m2, apnoea/hypopnoea index (AHI) 54 (29) events/h were treated with CPAP for at least 3 years. MVC records were obtained from the Ontario Ministry of Transportation (MTO) database for patients and an equal number of randomly selected control drivers. MVC rates were compared for 3 years before and after CPAP therapy for patients and for the corresponding time frames for controls.RESULTSUntreated patients with OSA had more MVCs than controls (mean (SD) MVCs/driver/year 0.18 (0.29) v 0.06 (0.17), p<0.001). Following CPAP treatment the number of MVCs/driver/year fell to normal (0.06 (0.17)) while, in controls, the MVC rate was unchanged over time (0.06 (0.17) v 0.07 (0.18), p=NS). Thus, the change in MVCs over time between the groups was very significant (change = –0.12 (95% CI –0.17 to –0.06), p<0.001)). The MVC rate in untreated patients (n=27) remained high over time. Driving exposure was not different following CPAP.CONCLUSIONSThe risk of MVCs due to OSA is removed when patients are treated with CPAP. As such, any restrictions on driving because of OSA could be safely removed after treatment.

Immediate Effect of Acupuncture on the Sleep Pattern of Patients with Obstructive Sleep Apnoea

2010 ◽  
Vol 28 (3) ◽  
pp. 115-119 ◽  
Author(s):  
Anaflávia O Freire ◽  
Gisele C M Sugai ◽  
Sônia Maria Togeiro ◽  
Luiz Eugênio Mello ◽  
Sérgio Tufik
Keyword(s):  
Obstructive Sleep Apnoea ◽  
Placebo Treatment ◽  
Acute Effect ◽  
Sham Acupuncture ◽  
Sleep Apnoea ◽  
Sleep Pattern ◽  
Control Group ◽  
Respiratory Events ◽  
Obstructive Sleep ◽  
Before And After

Background Most patients with obstructive sleep apnoea (OSA) do not tolerate treatment with nasal continuous positive airway pressure, the ‘gold standard’ treatment for this condition. It was shown in a pilot study that acupuncture was more effective than placebo treatment (sham acupuncture) in producing significant changes in the respiratory events assessed by polysomnography (PSG). Objectives To investigate the immediate effect of manual acupuncture (MA) and electroacupuncture (EA) on the sleep pattern of patients presenting with moderate OSA. Methods 40 patients with an Apnoea–Hypopnoea Index (AHI) of 15–30/h were randomly allocated to MA treatment (n=10), EA 10 Hz treatment (n=10), EA 2 Hz treatment (n=10) and a no-treatment control group (n=10). The patients received MA or EA (2 or 10 Hz) just before the PSG study at 20:00. Results The AHI (p=0.005; p=0.005), the Apnoea Index (p=0.038; p=0.009) and the respiratory events (p=0.039; p=0.014) decreased significantly in the MA and EA 10 Hz groups, respectively (AHI (21.9, 11.2), Apnoea Index (5.15, 0.7), respiratory events (120.5, 61.0) in the MA group before and after. AHI (20.6, 9.9), Apnoea Index (8.2, 0.3), respiratory events (117.0, 56.0) in the EA 10 Hz group before and after). The micro-arousals decreased only in the MA group (146.0 vs 88.5, p=0.0002). There were no significant changes in the EA 2 Hz group or in the control group. Conclusion A single session of either MA or EA 10 Hz had an acute effect in reducing the AHI as well as the number of nocturnal respiratory events of patients presenting with moderate OSA.

scholarly journals Anxiety and Depression in Patients with Obstructive Sleep Apnoea before and after Continuous Positive Airway Pressure: The ADIPOSA Study

2019 ◽  
Vol 8 (12) ◽  
pp. 2099 ◽  
Author(s):  
Almudena Carneiro-Barrera ◽  
Francisco J. Amaro-Gahete ◽  
Germán Sáez-Roca ◽  
Carlos Martín-Carrasco ◽  
Jonatan R. Ruiz ◽  
...  
Keyword(s):  
Continuous Positive Airway Pressure ◽  
Obstructive Sleep Apnoea ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Sleep Apnoea ◽  
Anxiety Symptoms ◽  
The State ◽  
Depression And Anxiety ◽  
Obstructive Sleep ◽  
Before And After

The prevalence and treatment response of depression and anxiety symptoms in obstructive sleep apnoea (OSA), although widely addressed in research and clinical settings, still remain unclear due to overlapping symptoms. The ADIPOSA study sought to elucidate the presence of non-overlapping symptoms of depression and anxiety in patients with moderate to severe OSA before and after continuous positive airway pressure (CPAP) treatment. Forty-eight adults aged 18–80 (68.75% men) with moderate to severe OSA were enrolled in this twelve-week longitudinal single-arm trial and completed a full-night ambulatory sleep diagnostic test and an assessment of cognitive-affective depression and anxiety symptoms using the Beck-Depression Inventory-Fast Screen (BDI-FS), the State-Trait Depression Inventory (IDER) and the State-Trait Anxiety Inventory (STAI). We found no cognitive-affective depression or anxiety symptoms of clinical relevance at baseline. The amelioration of depression and anxiety symptoms after CPAP use was only statistically significant when considering anxiety-trait (p < 0.01; d = 0.296) and euthymia (p < 0.05; d = 0.402), the distinctive component of depression. Although dysthymia or high negative affect remained unchanged, CPAP may be effective at reducing the lack of positive affect, a well-established health-protective factor. However, not until depression and anxiety disorders related to OSA are accurately measured in clinical and research settings will it be possible to obtain robust conclusions on the occurrence and amelioration of these symptoms after treatment.

scholarly journals Spatial distribution of pedestrian-motor vehicle collisions before and after pedestrian countdown signal installation in Toronto, Canada

2017 ◽  
Vol 25 (2) ◽  
pp. 110-115 ◽  
Author(s):  
Linda Rothman ◽  
Marie-Soleil Cloutier ◽  
Alison K Macpherson ◽  
Sarah A Richmond ◽  
Andrew William Howard
Keyword(s):  
Spatial Distribution ◽  
Spatial Patterns ◽  
Spatial Data ◽  
Motor Vehicle ◽  
Spatial Data Analysis ◽  
Motor Vehicle Collisions ◽  
Vehicle Collisions ◽  
Point Patterns ◽  
Kernel Density Estimates ◽  
Before And After

BackgroundPedestrian countdown signals (PCS) have been installed in many cities over the last 15 years. Few studies have evaluated the effectiveness of PCS on pedestrian motor vehicle collisions (PMVC). This exploratory study compared the spatial patterns of collisions pre and post PCS installation at PCS intersections and intersections or roadways without PCS in Toronto, and examined differences by age.MethodsPCS were installed at the majority of Toronto intersections from 2007 to 2009. Spatial patterns were compared between 4 years of police-reported PMVC prior to PCS installation to 4 years post installation at 1864 intersections. The spatial distribution of PMVC was estimated using kernel density estimates and simple point patterns examined changes in spatial patterns overall and stratified by age. Areas of higher or lower point density pre to post installation were identified.ResultsThere were 14 911 PMVC included in the analysis. There was an overall reduction in PMVC post PCS installation at both PCS locations and non-PCS locations, with a greater reduction at non-PCS locations (22% vs 1%). There was an increase in PMVC involving adults (5%) and older adults (9%) at PCS locations after installation, with increased adult PMVC concentrated downtown, and older adult increases occurring throughout the city following no spatial pattern. There was a reduction in children’s PMVC at both PCS and non-PCS locations, with greater reductions at non-PCS locations (35% vs 48%).ConclusionsResults suggest that the effects of PCS on PMVC may vary by age and location, illustrating the usefulness of exploratory spatial data analysis approaches in road safety. The age and location effects need to be understood in order to consistently improve pedestrian mobility and safety using PCS.

Cyclist-motor vehicle collisions before and after implementation of cycle tracks in Toronto, Canada

2020 ◽  
Vol 135 ◽  
pp. 105360 ◽  
Author(s):  
Rebecca Ling ◽  
Linda Rothman ◽  
Marie-Soleil Cloutier ◽  
Colin Macarthur ◽  
Andrew Howard
Keyword(s):  
Motor Vehicle ◽  
Motor Vehicle Collisions ◽  
Vehicle Collisions ◽  
Before And After

scholarly journals The effect of treatment for sleep apnoea on determinants of blood pressure control

2017 ◽  
Vol 50 (5) ◽  
pp. 1701261 ◽  
Author(s):  
Raquel Casitas ◽  
Elisabet Martínez-Cerón ◽  
Raúl Galera ◽  
Carolina Cubillos-Zapata ◽  
María Jesús González-Villalba ◽  
...  
Keyword(s):  
Positive Airway Pressure ◽  
Randomised Trial ◽  
Pressure Control ◽  
Sleep Apnoea ◽  
Newly Diagnosed ◽  
Nocturnal Hypertension ◽  
Obstructive Sleep ◽  
Before And After ◽  
Nocturnal Increase ◽  
Effect Of Treatment

Our aim was to assess the effect of continuous positive airway pressure (CPAP) on the nocturnal evolution of peripheral chemosensitivity, renin–angiotensin–aldosterone system activity, sympathetic tone and endothelial biomarkers in obstructive sleep apnoea (OSA) patients with isolated nocturnal hypertension (INH) or day–night sustained hypertension (D-NSH).In a crossover randomised trial, 32 OSA patients newly diagnosed with hypertension and without antihypertensive treatment were randomly assigned to 12 weeks of CPAP or sham CPAP. Peripheral chemosensitivity was evaluated before and after sleep using the hypoxic withdrawal test (%ΔVI).At baseline, D-NSH patients showed higher %ΔVI before sleep and higher levels of aldosterone and diurnal catecholamines. CPAP only reduced the nocturnal increase of %ΔVI in INH patients (6.9%, 95% CI 1.0–12.8%; p=0.026). CPAP-induced change from baseline in %ΔVI after sleep was 7.5% (95% CI 2.6–12.2%, p=0.005) in the INH group and 5.7% (95% CI 2.2–9.3%, p=0.004) in the D-NSH group. In contrast, %ΔVI before sleep only decreased with CPAP in the D-NSH patients (3.0%, 95% CI 0.5–5.6%; p=0.023).In conclusion, CPAP reduces the nocturnal increase of peripheral chemosensitivity experienced by INH patients and corrects the high daytime sensitivity of patients with D-NSH. Differences in response to CPAP between these patients can help better understand the mechanisms of perpetuation of hypertension in sleep apnoea.

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