By Dr JuanMulder
We have found over the past 3 years since the start of the combined sleep specialist clinic (CSSC), that working together has improved our clinical acumen. Though patients get referred for assessment of OSA or snoring, they often have concomitant sleep disorders.
Some of the American data1 from 2005 indicate that approximately a third of patients with sleep apnoea had another identifiable sleep disorder, usually requiring treatment. The most common were poor sleep hygiene (14.5%) and restless legs syndrome (8.1%). The other consideration is insomnia which can be present anywhere from 6 to 84%2 depending on the dataset studied. Parasomnia (sleep talking, acting out dreams, sleep eating, sexsomnia) is also increased to triple the rates compared to patients without OSA, as the sleep disruption from hypoxia is a trigger for these behaviours.
We have also picked up patients with narcolepsy type 2, which is supposed to have low prevalence of 1:2000. However, I suspect it is more common than presumed as diagnostic delay of up to 10 years is common with this ailment.
The key is to ask not simply about snoring and OSA, but also:
Ask about sleep hygiene and circadian body clock.
A feeling of ‘jumpy’ legs or arms before sleep.
Insomnia, which can be graded with the insomnia severity index.
Excessive sleepiness, vivid dreams and sleep paralysis especially if the severity of somnolence is out of keeping with the sleep study result.
The management of sleep apnoea is complex. Due to the unique collaboration between surgeon and physician, CSSC has delivered outstanding results to sleep apnoea patients in Melbourne. At CSSC Mornington, over 85% of non operated patients have successfully managed their sleep apnoea (2019-2021 audit)
Scharf, Steven & Tubman, Abby & Smale, Patricia. (2005). Prevalence of concomitant sleep disorders in patients with obstructive sleep apnea. Sleep & breathing = Schlaf & Atmung. 9. 50-6. 10.1007/s11325-005-0014-1.
Bjornsdottir E, Janson C, Gislason T, et al. Insomnia in untreated sleep apnea patients compared to controls. J Sleep Res. 2012; 21(2):131–8. [PubMed: 21988168]
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