A major Canadian insurance company (Desjardins Group) has incorporated sleep evaluation and therapy for Insomnia, Obstructive Sleep Apnea (OSA) and other common sleep disorders as part of their strategy to improve productivity, reduce workplace accidents and curb healthcare costs related to undiagnosed sleep disorders and their impact on other chronic

conditions (such as diabetes, hypertension, heart disease and mental health problems).

According to Desjardins research, poor sleep reduces concentration by 20 to 50 per cent, while insomnia accounts for one quarter of all costs related to workplace accidents. The resulting loss of productivity (”presenteeism”) is equivalent to 28 days of work per year – or an extra $5,000 per year for each employee with a sleep disorder.

Also according to this study, it may normally take up to 8 years for people with sleep apnea to seek help, which translates into productivity losses of tens of thousands of dollars – in addition to the well-known doubling in healthcare costs associated with untreated OSA.

Since approximately 40% of working adults report having sleep problems, but about 87% admit they have not discussed this with their doctor, the leaders of this project estimate that the implementation of this sleep health program will generate a return on investment of $10 for every dollar invested, with the program paying for itself as soon as a few employees have been treated.

Source: "Sleep Quality is a Significant Concern for Employers"

https://insurance-journal.ca/article/sleep-quality-is-a-significant-concern-for-em-ployers/

A new AAA study shows that approximately 10% of car crashes are due to driver sleepiness – 5 times more than previous estimates. AAA has a list of recommendations that include trying to schedule 7 hrs of sleep before a long trip, travel at times of the day when drivers are normally awake, napping as needed for 20-30 minutes, scheduling a break every 100 miles, and learning which medications / supplements are likely to cause drowsiness (see Roadwise Rx). Th AAA warns that in a sleep-deprived driver, the body’s pressure to sleep will typically override common tactics like drinking coffee, fresh air or singing. Typical signs that it is time to stop and take a break include having trouble keeping one's eyes open, lane drifting or not remembering details of the last few miles.

Source: Sleep Review Magazine, Drowsy Drivers Cause More Crashes Than You Think, AAA Foundation

Obstructive sleep apnea is approximately five times more common in patients with depression than in control participants and conversely, patients with obstructive sleep apnea are 5 times more likely to report depression (Cheng et al. 2013, Hayley et al. 2015, Wheaton et al. 2012). According to the authors of a study published in the Journal of Clinical Sleep Medicine, over 70% of people with sleep apnea experience symptoms of depression, leading the researchers to conclude that this very common sleep condition could be misdiagnosed as depression. The greater the severity of sleep apnea, the higher the likelihood of depressive symptoms, the researchers found.

Sleep apnea and depression share many common symptoms – persistent fatigue, daytime sleepiness, low vitality and concentration problems. There are several mechanisms likely to account for these findings: the sleep disruption and weight gain commonly associated with depression could cause or worsen obstructive sleep apnea; at the same time, obstructive sleep apnea could trigger or exacerbate depression by causing sleep disruption and inducing cognitive changes by intermittently starving the brain of oxygen (Povitz 2014).

However, clinically significant depressive symptoms remained in only 4 percent of the sleep apnea patients who were successfully treated for their sleep-disordered breathing (9 of 228 patients), with none of the treated patients persisting in their suicidal thoughts. According to another study by Povitz, the greatest improvement has been observed in those patients with the most severe depression.

This raises the possibility of new treatment approaches for depression, starting with simple questions about snoring, breathing pauses, interrupted sleep and excessive daytime sleepiness.

Sources:

https://aasm.org/cpap-therapy-reduces-symptoms-of-depression-in-adults-with-sleep-apnea/

https://www.medicalnewstoday.com/articles/299905.php

Cheng, Philip, et al. "Sleep‐disordered breathing in major depressive disorder." Journal of sleep research 22.4 (2013): 459-462.

Hayley, Amie C., et al. "The relationships between insomnia, sleep apnoea and depression: findings from the American National Health and Nutrition Examination Survey, 2005–2008." Australian and New Zealand journal of psychiatry 49.2 (2015): 156-170.

Wheaton, Anne G., et al. "Sleep disordered breathing and depression among US adults: National Health and Nutrition Examination Survey, 2005–2008."Sleep 35.4 (2012): 461-467.

Povitz, Marcus, et al. "Effect of treatment of obstructive sleep apnea on depressive symptoms: systematic review and meta-analysis." PLoS Med11.11 (2014): e1001762.

Patients with untreated sleep apnea showed mild cognitive impairment about 13 years earlier and Alzheimer’s disease 5 years earlier than patients with no sleep-disordered breathing, according to a 2015 Neurology study. However, treatment delayed the age of cognitive impairment onset by approximately 10 years.

Sleep-disordered breathing advances cognitive decline in the elderly

CPAP treatment could provide a solution to patients suffering from drug-resistant hypertension, according to a recent meta-analysis which looked at a multi-study pool of 300 patients using CPAP for a period between 3 weeks and 6 months. Obstructive sleep apnea has a striking prevalence of 83% in patients with drug resistant hypertension (high blood pressure which does not respond to three or more medications). While a number of studies have demonstrated statistically significant but modest improvement in blood pressure with CPAP therapy, the 2014 meta-analysis published in the Journal of Hypertension showed that for this difficult to treat population, the beneficial changes in systolic and diastolic blood pressure were considerably greater. Specifically, the study found a mean reduction of 7.21 mmHg in ambulatory systolic blood pressure (SBP), and 4.99mmHg in ambulatory diastolic blood pressure (DBP) from baseline after using CPAP therapy. While further research is needed to corroborate these findings, the study's principal investigator, Dr. Ulysses Magalang, hypothesizes that "untreated sleep apnea may be why these people haven’t seen improvement in their blood pressure despite the concurrent use of three or four medications”. Furthermore, the authors believe that "the longer the CPAP is used during the night, the greater the impact,” stressing the need for increased monitoring and support to improve treatment compliance. These changes could translate into a significant reduction in the risk of heart attack and stroke, and possibly a reduction in the medication burden, according to the study's authors, who urge more aggressive screening for sleep apnea in this population.

Sources

Iftikhar, Imran H., et al. "Effect of oral appliances on blood pressure in obstructive sleep apnea: a systematic review and meta-analysis." Journal of clinical sleep medicine: JCSM: official publication of the American Academy of Sleep Medicine 9.2 (2013): 165.

Sleep Review Magazine, April 6, 2015. "In Resistant Hypertension, Sleep Apnea Treatment Results in Greater Blood Pressure Reduction"

A study conducted at the University of Chicago demonstrated that with optimal use, one week of CPAP therapy reduced the mean 24-hr glucose levels and improved post-breakfast glucose response, as well as lowering the "dawn phenomenon" by 45% in type 2 diabetic patients with obstructive sleep apnea. In some patients, these effects were comparable to those produced by prescribed oral medications - a significant finding given that approximately 70% of type 2 diabetes patients suffer from OSA.

The National Health Sleep Awareness Project, an initiative funded by the Centers for Disease Control and Prevention in collaboration with the American Academy of Sleep Medicine, is advising all patients with Type 2 diabetes to be aware of their increased risk for obstructive sleep apnea, look for warning signs such as snoring, gasping or choking in their sleep and/or excessive daytime sleepiness, and talk to their doctor about further screening or testing for this chronic condition. According to Dr. Morgenthaler, president of the American Academy of Sleep Medicine, diagnosis and effective treatment of obstructive sleep apnea can improve glucose control and insulin sensitivity, helping patients better manage their diabetes.

Source: http://www.aasmnet.org/articles.aspx?id=5175

In a recently published case-controlled study of 150 CPAP-treated patients with OSA and type 2 diabetes, blood pressure and HbA1c levels were compared to those in matched patients who did not undergo CPAP therapy. After 5 years of treatment, the HbA1c level in the CPAP-treated group was 8.2% vs. 12.1% in the control group - a statistically significant difference that was accompanied by significantly lower blood pressure in the therapy group.

Corroborating these results, a 2014 review of 22 studies investigating the effect of CPAP treatment on patients with obstructive sleep apnea (OSA) and Type 2 Diabetes Mellitus (T2DM) or prediabetes found that 77% of the studies demonstrated significant changes in glucose metabolism with prolonged use of CPAP. Statistically significant changes were observed in HbA1C levels, postprandial or nocturnal glucose, and insulin sensitivity or resistance. In 4 out of the 17 studies showing improvement in glycemic control, these changes only manifested after 3 or more months of daily CPAP use, where compliance was defined as 4 or more hours of CPAP treatment per night. Based on these results, the review concluded that CPAP therapy may contribute to Type 2 diabetes prevention, as well as help already diagnosed patients slow down the progression of the disease.

Sources:

Gallegos, L., T. Dharia, and A. B. Gadegbeku. "Effect of continuous positive airway pressure on type 2 diabetes mellitus and glucose metabolism." Hospital practice (1995) 42.2 (2014): 31-37.

Guest, Julian F., et al. "Clinical outcomes and cost-effectiveness of continuous positive airway pressure to manage obstructive sleep apnea in patients with type 2 diabetes in the UK." Diabetes Care 37.5 (2014): 1263-1271.