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| Journal of the New Zealand Medical Association,
27-August-2010, Vol 123 No 1321
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This Issue in the Journal
Societal costs of obstructive sleep apnoea
syndrome
Philippa H Gander, Guy Scott, Kara Mihaere, Helen Scott Obstructive sleep apnoea syndrome (OSAS) is a treatable
disorder in which people experience multiple breathing pauses during sleep.
Untreated OSAS is associated with increased risk of other health problems and
increased sleepiness, causing increased risk of accidents. This paper estimated
the societal costs of OSAS among New Zealanders aged 30–59 yrs at $40
million per year (range $33–$90 million). The analyses suggest that
treatment is very cost-effective, by comparison with pharmaceutical treatments
that the government already funds for other conditions. Thus, this economic
analysis supports the case for improving the availability and accessibility of
services for the diagnosis and treatment of OSAS.
Exploring knowledge and attitudes of taxi drivers
with regard to obstructive sleep apnoea syndrome
Ridvan T Firestone, Philippa H Gander Obstructive sleep apnoea syndrome (OSAS) is a medical
condition where a sufferers’ airway is repetitively blocked completely or
partially during evening sleep. It results in fragmented sleep, daytime
sleepiness, high risk of motor vehicle accidents, and poor cognitive
functioning. There is research that suggests that OSAS may be highly prevalent
among professional drivers. Our study examined taxi drivers’ attitudes
about symptoms of OSAS (i.e. excessive daytime sleepiness, having a large neck
size as a proxy measure of Body Mass Index (BMI), snoring, and whether they
stopped breathing at night (as observed by their bed partners) and how these
views influenced their health and safety behaviours as professional passenger
drivers. We found that there is a lack of knowledge about OSAS symptoms and how
they are managed by the health professional, driver, and company managers. This
lack of awareness has led to drivers avoiding addressing these issues due to
fear of loss of employment and income. Clear guidelines for professional
drivers, company managers, and healthcare professionals on the diagnosis and
management of sleep disorders among drivers, and the potential consequences for
driver licensing is needed.
Improved speech discrimination after cochlear
implantation in the Southern Cochlear Implant Adult
Programme
Justine Bradley, Philip Bird, Penny Monteath, Elisabeth Wells The Southern Cochlear Implant Programme provides cochlear
implant services for adults and children with severe to profound deafness in the
lower North Island and South Island. This study looked at the ability of adult
patients to understand speech following cochlear implantation. The results show
a huge improvement in the ability to understand speech, which compares highly
favorably with results throughout the world. Older adults were able to benefit
just as much as younger adults. The majority of the improvement occurred within
six months of the people receiving their cochlear implants. Cochlear
implantation can provide enormous improvements in hearing and quality of life
for adults with severe to profound deafness.
Nasal fractures: patient satisfaction following
closed reduction
Rachelle L Love Nasal bone fracture can change the way the nose functions
and looks. Surgery after nasal bone fracture aims to restore the nose to a
satisfactory position. Results of surgery reported in the literature are mixed,
with some authors advocating extensive surgery at the start in order to avoid
the need for further surgery later on. This study demonstrates that manipulation
of the nasal bones during a brief general anaesthetic is successful in restoring
function and appearance in most patients and that few require further corrective
surgery.
Self-dilation for refractory oesophageal strictures:
an Auckland City Hospital study
Kenneth K S Wong, Dagmar Hendel The oesophagus (gullet) may be narrowed as a result of
injury and this may cause difficulty in swallowing. Traditionally, the area of
narrowing can be re-expanded using a gastroscopy or video tube study but some
patients need repeated procedures because of recurrent narrowing. The cost of
repeated gastroscopies is expensive; patients can instead elect to use
self-dilators which are specialised tubes that can be inserted by the patient
through the oesophagus and are cost-effective as patients can do this without
gastroscopy guidance. We report our experience of Auckland City Hospital
patients using self-dilators and demonstrate that self-dilators are
well-tolerated, easily administered and associated with minimal adverse
outcomes. However, patients need proper education and ongoing support for this
treatment to be effective.
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