With thanks to The Wellcome Trust
Poor quality of sleep
Erratic breathing is also associated with swings in blood pressure and heart rate, which may contribute to heart disease, stroke and metabolic conditions, such as diabetes. It is often the partners of patients who notice the problem first.
Loud snoring is usually present in sleep apnoea and, in addition to the obvious disturbance that this can cause, partners are often aware of short breaks in snoring when breathing appears to stop (apnoeas).
The good news is that we can treat the condition effectively. Initially a sleep study takes place – a patient spends the night in our sleep laboratory at Royal Brompton or Harefield hospitals, or takes one of our portable sleep study monitors home.
By tracking breathing throughout the night, we are able to diagnose the problem simply and quickly. One of the most frequently used and successful treatment methods for moderate and severe sleep apnoea is CPAP."
Continuous positive airway pressure (CPAP)
CPAP machines deliver air via a lightweight mask throughout the night. The air is gently pressurised and so keeps the airways open at all times. Although patients are sometimes daunted by the idea of sleeping in a mask, they soon get used to it and outcomes are extremely good.
Their partners are usually grateful too – by ensuring the airways do not become obstructed, the snoring promptly stops! Milder cases respond to weight loss or a dental splint (mandibular advancement splint) that simply fits over the teeth at night.
CPAP machines have also been used successfully in small children who suffer from breathing problems due to conditions such as craniofacial disorders, floppy muscles, obesity or Down’s syndrome.
A key new development is that sleep-disordered breathing is now implicated in the progression of heart failure. A current research project in the unit, in conjunction with cardiologists, has shown that sleep apnoea (predominantly central sleep apnoea) occurs in 40 per cent of individuals with mild heart failure. This opens up exciting new avenues of non-pharmacological (drug-based) therapy.
Help for patients at home
One of the other major areas of work undertaken at Royal Brompton Hospital is domiciliary ventilation; we are the largest European centre providing this service and take referrals from right across the country.
For adults and children with neuromuscular and chest wall conditions such as muscular dystrophy and curvature of the spine, the outlook was bleak until relatively recently. Non-invasive ventilation using small portable ventilators at night, extends survival, reduces hospital admissions and improves quality of life.
Even in common disorders such as chronic obstructive lung disease (COPD), non-invasive ventilation can be used to improve the outcome from acute infections.
We are currently exploring new types of ventilator which may be easier to use for patients with problems such as motor neurone disease.
Read a patient's account of what it is like coming in for a sleep study.