Bibliography

Bibliography

According to Eurostar, 5.720 people die each year in the EU as a result of work-related accidents and 3,1% of all workers have suffered at least one injury.

  1. In total, 29% of fatal accidents and 4% of non-fatal accidents are due to losing control of a means of transport, and a significant number is due to undiagnosed cases of sleep apnea.
  2. Patients with OSA (Obstructive Sleep Apnea) have 2,6 times the work disability compared to non-OSA controls and the risk increases up to 13,7 times in the OSA with associated sleepiness.
  3. In Italy, the health cost of occupational accidents related to OSA amounted to € 101.083.761.

Antonio Sanna, Chronic Respiratory Disease 2012; 10: 29 13

 

Occupational accidents and OSA

  1. It increases beyond professional transport and due to work disability.
  2. The treatment of OSA solves the reduction of apnea and the improvement of work performance with expected benefits in work processes and business in general.
  3. The risk assessment of OSA in workers can also help reduce the burden of national health care systems.

Sales SN, et al. Sleep 2016;39:1211-18
Antonio Sanna Chronic Respiratory Disease 2012; 10: 29-13

 

Quality of life and Apnea

  1. OSA has a relevant impact on the quality of life and numerous investigations have already demonstrated decreased quality of life in patients with OSA.
  2. CPAP and jaw advancement devices reduce subjective sleepiness and improve the quality of life of both patients and their partners.
  3. There are few studies that have evaluated the impact of mild OSA (Obstructive Sleep Apnea) on quality of life, with conflicting results from population studies.

Chowdhuri S, et al. Am J Respir Crit Care Med 2016; 193: 3-37-e54
Karkoulias K, al. Eur Rev Med Pharmacol Sci 2013; 17: 531-6
Sicoli MM, et al. Sleep 2008; 31: 1551-8
Lopes C, et al. Braz J Med Biol Res 2008; 41: 908-13

 

Sleep apnea and sexual dysfunction

Various studies have confirmed that sexual dysfunction exists in both men and women who suffer from snoring or sleep apnea. For men, it manifests itself as erectile dysfunction and impotence. And for women, it causes problems related to sexual satisfaction.

It has been known for some time that changes in sleep architecture affect testosterone levels.

A study conducted on nearly 1000 Danish subjects revealed a direct relationship between poor sleep quality and decreased sperm quality and motility.

Jensen TK et et al. Am J Epidemial 2013;177:1027-37

 

The Hospital Clínic in Barcelona conducted an experimental study on animals. Two groups of mice were subjected to different concentrations of oxygen. The first group breathed the surrounding air, while the second group breathed air with a low level of oxygen. For 40 seconds, the air contained 21% oxygen and then for 20 seconds, 5%. This was repeated six hours a day for 30 days.

Sperm mobility, fertility and oxidative stress variables at the testicular level were measured. The conclusions were, in the group of mice subjected to the lack of intermittent oxygen the physiological protections against oxidative stress were reduced, the fertility measured by the mobility that the sperm had, decreased significantly, and the same happened with the number of intercourse and with how many of them they managed to produce a fetus.

Torres M. et al. Sleep 2014;37:1757-63

 

Neurocognitive impairment and sleep apnea

  1. OSA is associated with deficiencies in attention/alertness, long-term visual and verbal memory, eye diseases/verbal construction skills and executive functions.
  2. Support with CPAP or mandibular advancement devices can improve neurocognitive dysfunction, but the effect decreases in OSA patients who do not suffer from drowsiness.
  3. 2017. Studies identified six areas of the brain showing a loss of gray matter. (Sri Yan, et al. Sci Rep 7;10095:XNUMX).

Rosenweiz I, et al. EbioMedicine 2016; 7: 221-9
Davies CR, et al. Sleep Med Clin 2016;11:287-98
Zhou J, et et al. Sleep Med 2016;23:99-108
Bucks RS , et et al. Respirology 2013;18:61-70
O 'Donoghue FJ, et al. Sleep 2012;35:41-8
Kushida CA, et al. Sleep 2012;351593-602

 

The inmense majority of the population is undiagnosed

Chronic deprivation of sleep or poor quality sleep produces physiological changes at various levels, on the metabolic control on the consolidation of memory, on the regulation of emotions and on the activation of the immune system. In addition, these individuals have problems in their social lives and intimate relationships, which are limited due to their snoring. It is a very serious problem. Studies from around the world show that the prevalence of sleep apnea is quite high. Between 15% to 20% of cases involve individuals with more than 15 apneas per hour of sleep. If we confine ourselves to Spain, the data speak of very high figures, 15 millions of subjects suffer from sleep apnea at least to some degree. And an 7% in its most severe forms.

In Spain, only 10% to 20% of individuals are diagnosed out of the total number of existing cases. Other countries are well below these figures. A population-based study in Switzerland conducted on 57-year-old individuals who were NOT obese found that 50% of men and 15% of women had more than 25 apneas per hour of sleep. This finding is a three- to seven-fold increase in the data available for all the statistics. Furthermore, it was linked to hypertension, diabetes, depression and metabolic syndrome, which means that this information is reliable. The prevalence of sleep apnea is three times higher in later years and OUR SOCIETY IS AGING.

 

Consumption of health resources

Studies have shown that patients with sleep apnea have higher health care expenditures — around two to three times higher than patients without sleep apnea. Even when compared to one another, once patients have been diagnosed and followed for five to ten years, we find that despite being older they consume LESS health care resources.

 

Diagnosing patients saves money

Studies support this assertion. Undiagnosed patients consume between $2000 and $4000 per person. When they are treated, the savings range between $3000 to $5000 per year.

This is an important fact: the Basque Country is the region in Spain with the highest expenditure per patient. This means that the total expenses greatly exceed this amount per person.

 

Treating sleep anea patients saves the government great amounts of money

  • 30 millions of people suffer from sleep apnea in the USA. In 2015, 12 million dollars were allocated, of which 50% went to assisted breathing machines, 43% to surgeries to solve the problem, and the remaining 7% to diagnostic visits.
  • The expense originated by the rest of patients where 80% is undiagnosed was 149.6 trillions of dollars.
  • The cost for the state of diagnosing the 80% of undiagnosed cases is $49.5 billion.
  • Diagnose saves money. Each dollar for treatment saves 3.5 dollars to the state. Study published in the Journal Clinic in the year 2016 by Sleep Medicine.
  • Sleep apnea causes more death than wars, epidemics and terrorism, and it kills a segment of the population that is in its prime: the middle-aged generation.
  • Having sleep apnea entails a high risk of suffering both work- and traffic-related accidents, increasing the risk two to seven times.
  • Inattentiveness resulting from drowsiness is present in 30% of accidents.
  • 3% of workers worldwide suffer accidents at work. Of these accidents, 29% are related to the loss of control of means of transport or to an undiagnosed sleep apnea.
  • Traffic accidents are the 4th leading cause of death worldwide.

In the 90s, a study was conducted with 102 traffic drivers. This study, based on results that were gradually produced, gave rise to Spanish Royal Decree 772/1997, which requires the diagnosis and monitored treatment of sleep apnea before being able to obtain or renew a driving license. This was the first regulation of its kind in Europe — we pioneered it. (It has been in effect in Spain since 2017) In 2014, the European traffic directive 85/1997/EU was approved, which is equivalent to the Spanish Royal Decree of XNUMX.

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