Sleep Disorders and Sleep Deprivation: An Unmet Public

Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem
http://www.nap.edu/catalog/11617.html
CONSEQUENCES OF CHRONIC SLEEP LOSS AND SLEEP DISORDERS 75
tional study of a large cohort of sleep apnea patients (n = 403), snorers, and
healthy controls who had been followed for an average of 10 years, found a
threefold higher risk of fatal cardiovascular events with severe OSA (Marin
et al., 2005). An observational follow-up study of the long-term effects of
CPAP therapy on mortality found that compared to individuals that began
receiving CPAP therapy for at least 5 years (n = 107), individuals that were
untreated with CPAP (n = 61) were more likely to die from cardiovascular
disease (14.8 percent versus 1.9 percent, log rank test, P = .009) (Yaggi et
al., 2005; Doherty et al., 2005).
Treatment
In adults, OSA is most effectively treated with CPAP and weight loss
(Strollo et al., 2005; Grunstein, 2005a). Evidence of CPAP’s efficacy for
alleviating daytime sleepiness comes from randomized controlled trials and
meta-analysis (Patel et al., 2003). The problem is that many patients are
noncompliant with CPAP (see Chapter 6). Other options, although less effective,
include a variety of dental appliances (Ferguson and Lowe, 2005) or
surgery (e.g., uvulopalatopharyngoplasty) (Powell et al., 2005). In children,
the first-line treatment for most cases of OSA is adenotonsillectomy, according
to clinical practice guidelines developed by the American Academy
of Pediatrics (Marcus et al., 2002). Children who are not good candidates
for this procedure can benefit from CPAP. Central apnea treatment is tailored
to the cause of the ventilatory instability. Commonly used treatments
include oxygen, CPAP, and acetazolamide, a drug that acts as a respiratory
stimulant (White, 2005).
INSOMNIA
Manifestations and Prevalence
Insomnia is the most commonly reported sleep problem (Ohayon,
2002). It is a highly prevalent disorder that often goes unrecognized and
untreated despite its adverse impact on health and quality of life (Benca,
2005a) (see also Chapter 4). Insomnia is defined by having difficulty falling
asleep, maintaining sleep, or by short sleep duration, despite adequate opportunity
for a full night’s sleep. Other insomnia symptoms include daytime
consequences, such as tiredness, lack of energy, difficulty concentrating,
and/or irritability (Simon and VonKorff, 1997). The diagnostic criteria
for primary insomnia include:
• Difficulty initiating or maintaining sleep or nonrestorative sleep.
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