Dr. David Dawson - Anaesthetist and Consultant on Sleep Apnoea

David explained that he started work at Bradford Royal Infirmary in November 1986 as an Anaesthetist. He retired last week but will still be going back on a regular basis as a Consultant on Sleep Apnoea.

David first discussed why we snore. Basically, as we relax in sleep the airways narrow and the soft floppy bits in the throat start to obstruct the airway. This causes snoring for several reasons - anatomy, weight gain, as we age muscles lose their tone, big tonsils and rare but importantly tumours.

Sleep Apnoea is the next stage on from snoring where the airway closes of completely. This causes oxygen levels to fall which then drags you out of deep sleep into light sleep. This can happen hundreds of times per night.

Why is this a big deal? The prevalence of the problem is increasing rapidly. In 1993 4% of men and 2% of women suffered from sleep apnoea but it is now 10% of men and 5% of women. This is a result of the trends in obesity which has increased 50% in the last 25 years and severe obesity has doubled in the same period. The consequences if untreated are sleepiness, cardiovascular problems, gastroesophageal reflux disease (GORD), depression and erectile dysfunction.

David explained that he got involved in this area because as an anaesthetist sleep apnoea increases the risk of problems whilst anaesthetised.

He said the excessive daytime sleepiness caused by the sleep apnoea has critical impact on drivers and doctors have an obligation to notify DVLA if they think a patient has a case of uncontrolled sleep apnoea. But this is not the only area affected. Employees in any job where vigilance is critical need to take actions to overcome their problem. Examples he gave were workers in Chemical, Nuclear, Ships, and Rail industries. David said that he has frequently been called upon to review workers in a particular company only to find that because of the stress and their lifestyles the board members also suffered from the problem.

To test groups of workers for sleep apnoea David asks them all to complete a questionnaire. Then those who might be at risk of the problem based upon their answers are measured for oxygen and respiration while asleep using various different devices. This test comprises a blood oximetry test that measures the oxygen level and also the blood pressure surges that are caused by sleep apnoea.

The treatment for this is a CPAP machine which pumps ordinary room air into the mouth / nose at pressure. This pressure forces the airways to stay open. There are a variety of different masks to deliver this air.

David said that in the future it was expected that peripheral arterial tonometry would be linked to a person's smart phone so that a person could do a self-check for sleep apnoea. This would then allow them to treat themselves.