The Interactions between Sleep Disordered Breathing, Metabolic Syndrome and Vascular Risk.

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We will look at two common diseases in the Australian community, the metabolic syndrome and obstructive sleep apnoea (OSA), and explore the common links they have to the risk of disease of the heart and blood vessels. We will then take a group of patients who have both diseases, treat the OSA, and assess the impact of this treatment on their cardiovascular health. Metabolic syndrome is a term given to patients who have high blood sugar, obesity, high lipid levels and raised blood pressure. The Australian Bureau of Statistics estimates that half the Australian population is overweight, and US studies suggest that nearly of the adult population has metabolic syndrome. This is strongly linked to diseases of the heart and blood vessels, eg heart attacks and stroke. Patients with OSA stop breathing during the night when their throat closes over. The blood oxygen falls, which causes the patient to wake momentarily, then start breathing again. This cycle repeats itself throughout the night. The usual treatment is an air pump (CPAP) connected to a nose mask, which blows air into the throat and prevents closure. This disease is strongly linked to high blood pressure, raised blood sugar levels and heart and blood vessel disease. Patients with the metabolic syndrome will have an overnight sleep study to diagnose OSA, giving the likelihood of having OSA in this group of patients. They will then have extensive investigations of the health of their heart and blood vessels. From these, we will determine which aspects of OSA are more likely to result in cardiovascular disease. Those patients diagnosed with OSA will be treated with CPAP for 3 months. Half the patients will receive normal CPAP; the other half will receive ineffective CPAP. They will then be re-tested and we will compare the results before and after treatment. Thus we will measure likelihood of OSA in this large group of patients, and the health benefits they may gain from treatment of their OSA.