Treatment of severe obstructive sleep apnea syndrome with a chinstrap.

A chinstrap alone improved severe obstructive sleep apnea as well as or better than the use of CPAP.

Overweight and obese patients in a primary care population report less sleep than patients with a normal body mass index.

BACKGROUND: Insufficient sleep and obesity are common in the United States. Restricted sleep causes important neurocognitive changes, including excessive daytime sleepiness and altered mood. This may result in work-related injuries and automotive crashes. Evidence links sleep loss to hormonal changes that could result in obesity. This article examines the association between restricted sleep and obesity in a heterogeneous adult primary care population. METHODS: A total of 1001 patients from 4 primary care practices participated in this prospective study. Patients completed a questionnaire administered by a nurse or study coordinator concerning demographics, medical problems, sleep habits, and sleep disorders. Professional staff measured height and weight in the office. The relationship between body mass index (BMI) and reported total sleep time per 24 hours was analyzed after categorizing patients according to their BMI (calculated as weight in kilograms divided by the square of height in meters) as being of normal weight (<25), overweight (25-29.9), obese (30-39.9), or extremely obese (> or =40). RESULTS: Analyzable forms from 924 patients aged between 18 and 91 years indicated that (1) the mean BMI was 30; (2) women slept more than men; (3) overweight and obese patients slept less than patients with a normal BMI (patients reported less sleep in a nearly linear relationship from the normal through the obese group); and (4) this trend of decreasing sleep time was reversed in the extremely obese patients. CONCLUSIONS: This study found that reduced amounts of sleep are associated with overweight and obese status. Interventions manipulating total sleep time could elucidate a cause-and-effect relationship between insufficient sleep and obesity.

Sleep disordered breathing and driving risk.

Obstructive sleep apnea syndrome leads to an increased risk of motor vehicle accidents through multiple pathways. Sleep apnea and motor vehicle crashes are common, and motor vehicle collisions are the leading causes of death amongst accidents. Therefore, the clinician charged with the care of apneic patients must address the issue of safe driving. Some recent evidence reveals that driving simulator technology may discriminate apneic drivers from control drivers as well as those apneics at a lesser risk for automobile crashes. This same tool demonstrates an improvement in driving capabilities to baseline when patients with sleep apnea are treated with nasal continuous positive airway pressure and that this improvement may occur rapidly. The prevention of driving accidents in patients with sleep apnea appears cost effective. Educating the patient with sleep apnea about sleepy driving and objective documentation of treatment efficacy are important in reducing the likelihood of accidents.