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Sedentary workers at risk for sleep apnea

If your job chains you to a desk for much of the day, it could be increasing your chances of developing a serious sleep disorder, according to a landmark study by Toronto researchers.

The study revealed that fluids tend to accumulate in the legs of some people who spend a lot of time sitting. When they lie down at night the fluids redistribute to the upper body, including the neck. This fluid shift can narrow the airways and make it difficult to breathe, leading to obstructive sleep apnea.

"The idea that fluid movement is responsible for sleep apnea is, in some ways, revolutionary," said lead researcher Douglas Bradley, director of the Sleep Research Laboratory at the Toronto Rehabilitation Institute. "No one has considered this before."

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Sleep apnea occurs when the soft tissues in the throat essentially collapse shut, blocking air flow. Those with the condition must wake briefly many times a night to gulp for air. They will have no recollection of waking, but suffer the consequences - fatigue the following day - of a poor sleep.

Even worse, sleep apnea puts an incredible strain on the heart and raises the risks of high blood pressure, heart attacks and strokes.

Doctors have long known that obese individuals, who snore a lot, are prone to sleep apnea. It has been assumed that extra flesh around the throat contributes to night-time breathing problems.

But researchers have been at a loss to explain fully why the disorder also afflicts people of normal weight. About 9 per cent of men and 4 per cent of women develop apnea - and 60 per cent of them are not obese.

Dr. Bradley's study may have finally solved the mystery. In an overnight sleep lab, his team examined 23 non-obese, apparently healthy men with the condition.

"We found the more fluid that moved out of the legs over night, the bigger their necks got and the worse sleep apnea they had," Dr. Bradley said. On average, the men's neck circumference increased by a centimetre.

The results, published in the American Journal of Respiratory and Critical Care Medicine, could lead to new treatment options to eliminate the disorder or reduce its severity.

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For instance, just getting up and walking around more frequently could help reduce the buildup of fluid in the legs. Medication might also be used to minimize fluid retention. Or the head of the bed could be elevated to prevent night-time fluid shift.

Right now, the main method of treating sleep apnea is with a CPAP (continuous positive airway pressure) device that blows pressurized air into the throat to keep it open. But many patients find it difficult to sleep with a mask strapped to their face.

REVEALING FIGURES

This week, the release of two separate reports painted a revealing picture of our global health priorities.

One of the articles, published in The New England Journal of Medicine, dealt with the issue of how pharmaceutical companies try to influence doctors with various gifts - such as complementary meals, trips and other goodies.

Although the number of freebies has declined in recent years, it still represents "an important component of the approximately $7-billion [U.S.]that drug companies spend annually on promotion to medical professions in the United States," Robert Steinbrook wrote in the journal.

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The $7-billion is just the tip of the marketing iceberg. Billions more are spent on ads aimed directly at U.S. consumers - and that doesn't include worldwide sales activities.

The other report represents the first global survey of how much money is spent on research for "neglected diseases" such as malaria, leprosy and diarrheal illnesses that primarily strike people in developing countries.

There is little financial incentive for pharmaceutical companies to develop treatments for people who can't afford to buy them. So much of the $2.5-billion spent annually on neglected diseases comes from charities and national governments, according to the report published in PLoS Medicine. And 80 per cent of this money is earmarked for just three areas - malaria, tuberculosis and AIDS. Most of the other neglected diseases receive a relative pittance.

Mary Moran of the George Institute for International Health in Sydney, Australia, the lead author of the report, says more research money is needed. But she thinks it would be wrong to expect it to come from drug companies. After all, they are private corporations that are going to look after their own financial interests, she said. Wealthy developed nations, she believes, should be shelling out more.

Still, the numbers are thought-provoking - $7-billion on sales promotion, $2.5-billion on neglected diseases.

A TRANSPLANT FIRST

U.S. doctors hope that a new surgical procedure will encourage more women to donate kidneys to those who are in need of a transplant.

Using the novel approach, the organ is removed through the vagina, sparing the need for a significant abdominal incision. Doctors at Johns Hopkins University school of medicine in Baltimore, Md., say the operation results in less pain, scarring and recovery time than the usual surgery.

They performed the first transvaginal kidney removal on Kimberly Johnson, who

donated her organ to an ailing niece. "It was easier than childbirth," Ms. Johnson, 48, told The Associated Press.

In recent years, a growing number of people have given up one of their kidneys to a relative, friend or even a stranger because of a general shortage of transplantable organs. We are normally born with two kidneys, although people in good health can get by with one.

ptaylor@globeandmail.com

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