Interview with Professor Maria Bonsignore, sleep and breathing expert
Professor Maria Bonsignore researches sleep and breathing disorders, including obstructive sleep apnoea (OSA), at the University of Palermo in Italy. Here she talks to us about breathing problems that can affect people while they are asleep, and what the future holds for sleep and breathing research and medicine.
Could you introduce yourself and tell us about your interest in sleep and breathing?
I have been involved in sleep and breathing research for a long time. When I started, the way the upper airways worked and the effects of obstructive apnoeas (where someone stops breathing) during sleep were largely unknown, and we were interested in this entirely new research field. Now we know a lot, not only about sleep, but also about the different types of breathing problems that can happen during sleep, and technology has allowed major growth in the field compared to 35 years ago.
There are, however, major questions that need to be answered in order to provide better care to our patients, and there is still need for good research. Increasing knowledge on the role of the nervous system in sleep, and recognition of poor sleep as a problem in our society, make sleep and breathing as fascinating as it was in the early days.
What can go wrong with breathing when people are asleep?
We all breathe less during sleep than during wakefulness, and this is especially true in people with respiratory disease whose conditions can deteriorate at night. Obstructive sleep apnoea (OSA) is the most common form of sleep disordered breathing and is due to collapse of the upper airways during sleep. This happens because of a combination of factors: for example, obesity, the structure of the upper airways, reduced activity of muscles in the upper airways and hormone disorders can all contribute. Snoring is the main symptom of OSA, and people who snore and have a poor quality of sleep or excessive daytime sleepiness should talk to their doctor.
The European Lung Foundation is looking for people with sleep apnoea to become members of a new patient advisory group. How important do you think patient input is for research on sleep apnoea?
Collaboration with patients is important to improve care of all respiratory diseases, and sleep apnoea is no exception. Patients can help us improve our attitudes, and collaboration between doctors and patients is essential to highlight problems that may impact treatment. Along the same line, patient inputs for clinical research are highly welcome.
Next month you are chairing a conference on Sleep and Breathing – what are you most looking forward to about this conference?
I expect to hear about the latest research findings on sleep and sleep disordered breathing. In this respect, cooperation between the European Respiratory Society and the European Sleep Research Society is very important. It could really improve the daily practice of healthcare professionals involved in sleep medicine who do not always have an opportunity to be exposed to sessions about the nervous system and sleep.
This year there is also an opening to dentists interested in sleep disordered breathing, since they are having their meeting nearby and can participate in some sessions of Sleep and Breathing on mandibular advancement devices (devices that are worn to help people breathe while sleeping).
What do you think the future holds for people with sleep apnoea?
Current research on sleep apnoea is exploring new and personalized treatment options. The acceptance of continuous positive airway pressure (CPAP; a way to keep the airways open using air pressure) by patients is often low. We need to propose new treatments, such as new drugs, to help patients breathe as effectively as they do with CPAP. Our efforts are now concentrated on one hand in the development of such drugs, and on the other hand on the identification of patients who are at high risk for complications and therefore need more attention. Treatment of obesity may also help to treat OSA, and we also need new drugs in this field.