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More Lives Lost Through Undiagnosed Sleep Apnoea
This article has really touched me and, although it's sad, I want to share it as a reminder to ourselves we must never drive if our treatment is going wrong and we feel sleepy, but also in the hope that others may read it and it will encourage people who suspect they may have sleep apnoea, to seek help. 3 lives have been lost through a suspected sleep apnoea sufferer falling asleep at the wheel. So sad......
A loving father fell asleep at the wheel killing himself and two members of his family on the way back from a sunshine holiday, an inquest heard today.
Stephen Padden, 56, was suspected to be suffering from a sleep disorder when he nodded off just a few miles from their Porthcawl home.
The father-of-three was driving from Gatwick Airport after a surfing holiday in Morocco when he crashed off the M4 near Cardiff.
Retired BT engineer Mr Padden was killed along with his son, Tom, 20, and partner, Louise Evans, 23.
Mr Padden’s wife Suzanne, 51, miraculously survived the crash, along with their grandson Logan, six months, who was strapped into a car seat.
Logan suffered only a minor cut to the face but was left an orphan too young to remember his mother and father.
The inquest heard the three who died were not wearing seatbelts when the Peugeot 406 hit a crash barrier on the M4 near junction 33.
Nursing manager Mrs Padden told the hearing how she had booked afternoon flights back from Morocco to avoid her husband driving late at night.
But the flight was delayed for five hours and the family landed at Gatwick at 7.45pm before setting off on the four-hour drive back to Wales.
Mrs Padden said: “As a qualified nurse, I believed that Stephen had some sort of sleep disorder.
“I booked the afternoon flight to avoid him driving at night. But because of the delay we didn’t arrive until the evening.
“I can’t be sure that made Stephen any more tired but it certainly didn’t help.”
Mrs Padden said her husband “was not himself” during the holiday and said Warfarin tablets he was taking for deep vein thrombosis were giving him flushes.
She told the inquest how they stopped for a meal and coffee on a service station en route.
She said: “I asked Stephen if he wanted me to drive but he said he was fine after the coffee.
“I fell asleep and the next thing I remember the car was rolling and there were loud bangs. It felt like a dream.
“My first reaction was for the baby but I could see he was in his car seat. To my horror no-one else was in the car.
“I was screaming. I could see that Tom was lying in the road and I could tell he was critically injured.
“Further down I could see two bodies – they were not moving and I presumed they were dead.”
She told how Mr Padden would stop breathing for 12-14 seconds at a time when he was asleep before taking a “deep breath”.
Mrs Padden said: “I kept on to him to see his doctor if there was a problem. If he went to the doctor he did not follow up any advice.”
The inquest heard the family GP said Mr Padden had not been treated for sleep disorder.
Mrs Padden was wearing a seatbelt but the other three members of her family had been thrown out of the car in the crash just before midnight on January 17 of this year.
The inquest heard 999 crews arrived to pronounce Mr Padden and Miss Evans dead. Tom Padden died the next morning in hospital.
Drivers on the M4 told how the Peugeot – with two distinctive surfboards on the roof – “zoomed” past them.
Driver Gemma Beveridge, 23, told the hearing she was worried about the way it was being driven in “spurts”, going fast, then slowing down and wavering between lanes.
She said: “I was not sure if it was boy racers or if the driver had fallen asleep at the wheel.
“I remember thinking what on earth was he doing. I saw him hit the barrier and there were sparks as the car went up in the air.”
Miss Beveridge stopped to help and was handed six-month-old baby Logan by distraught Mrs Padden at the roadside.
Pc Philip Painting, who investigated the crash, said: “If they had their seatbelts on they would have remained in the vehicle and their injuries would have been significantly reduced.”
The surfing-mad family, of Porthcawl, had been on a week’s holiday to Morocco.
Tom Padden was a former Welsh junior surfing champion and hoped to make a living out of it.
The family had posed for happy family photographs with Logan shortly before they flew home.
Cardiff coroner Mary Hassell said: “Stephen’s driving was erratic. He was braking and speeding up. He didn’t apply the brakes at the time of the accident.
“It seems to me extremely likely that Stephen fell asleep at the wheel and then, to compound that, they were not wearing their seatbelts.”
She recorded three verdicts of accidental death.
A statement from the family said: “Louise, Thomas and Stephen passed away as a result of a tragic accident. Their death has left a huge void in the lives of so many, it has left a young child without parents and grandfather.
“All family members would like to thank everyone for their support.
“Tom had taken to being a father as he did everything else in life, without fear and with total conviction.
“He had been a wonderful father and we watched him become a man.
“He was devoted to Louise and their baby son, Logan, who would spend hours watching him surfing.
“Louise was the perfect match for Tom and would have been a wonderful mother. For a couple so young they were remarkable parents.”
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Replies to This Discussion
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Permalink Reply by Richard Mundy on
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This is a desperately tragic case, made all the worse by having an orphaned baby involved.
It is not clear from the account whether Stephen Pedden had actually sought treatment for his sleep apnoea, or whether his GP could not recognise his symptoms.. From his picture on the BBC website, he seems a well-built sort of fellow, just the sort of candidate for OSA.
OSA is a life-style disorder, as we know, characterised by the patient being over-weight. It is reckoned that these days around 35% of men of working-age are over-weight or even obese. This becomes pretty much the average profile, then, of patients presenting at a GP's surgery; the GP's most likely response to an over-weight patient, for the umpteenth time that day, is to say 'Go home, start dieting and come back in six month's time when you've lost three stones.' and 'Of course you feel tired, you're carrying too much weight around.'
Taking a pulse, his blood-pressure and sounding the chest won't reveal OSA, so that's another opportunity wasted. At present it can take two years of visits to the GP before getting a referral to a respiratory specialist. How many men would persevere for that long, knowing all too well that when they are finally diagnosed, they have to surrender their driving-licence and possibly lose their job.
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Permalink Reply by Kath Hope on
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I'm the same as you Mary. I never drive if I'm going through a rough patch in my treatment and am feeling really tired. I know first-hand what it's like to lose someone through some else's fault. Years ago, my Grandma (who was like a mother to me) was knocked off her bicycle by a man who had a blackout at the wheel of his car. He had felt unwell and his wife begged him not to drive and said they should catch a bus, but he insisted he was fine. Well he wasn't and that was the end of my Grandma :(
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Richard - Yes it is tragic and the sooner more awareness of sleep apnoea is spread throughout the UK the better. Also the myth that a person who drives for their occupation needs to be exposed, as a lot of people are under the impression that they have to kiss they jobs goodbye. This isn't the case, as once the treatment is proved to be working, they can drive again. In most parts of the country, the timespan between diagnosis and getting a CPAP is much less now, which is also a good thing.
A lot of GP's also need educating too, as you've pointed out!
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This case has created a good deal of interest, mainly because it goes straight to the heart of 'family life', or death, as the case may be, in the most tragic circumstances.
I received a phone-call this morning from a lady in Woking whose son had recently died of sleep apnoea at the age of 43. He was on CPAP therapy and was not over-weight. He lived alone and it was the neighbours who found him dead in bed; the police called at her home at 6.00am to bring the news.
The inquest result was that he died of sleep apnoea , exacerbated by a heart condition. The poor woman is most distressed, as you can imagine, and has found it impossible to get any help or support from the established sleep-clinics that she has called. I hope I was able to put her fears to rest.
I have asked for a copy of the post-mortem report on the driver in South Wales who lost his own life as well as his son and daughter-in-law: the coroner has told me sleep apnoea did not contribute to his death.
Until sleep apnoea is swept from under the carpet, people will continue to hold on to their old ideas:'It's nothing to worry about.' - that's all very well, but if your wife or husband pokes you in the ribs during the night and says: 'You stopped breathing.', you must take it seriously, it means there is something wrong, and you must do something about it.
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Oh, the poor lady, and to think that she got no support from the sleep clinics. So sad...... I would hazard a guess that it was the undiagnosed sleep apnoea that her son probably had for many years which had caused the heart problem. The number of times I've come across people who have discovered they have sleep apnoea 'after' the heart attack or stroke. If only they'd known years earlier these other problems may have been avoided.
As for the coroner stating sleep apnoea wasn't to blame for the Wales tragedy, how on earth could he make that bold statement? The man fell asleep at the wheel, his wife had suspected sleep apnoea - and we all know just how sleep deprived that makes a person. Conclusion:- if his wife was correct in her suspicions then sleep apnoea was to blame. Just like if he had insomnia or any other condition that causes sleep deprivation, that would have been to blame.
Yes, sleep apnoea needs exposing. I seem to remember how people used to brush diabetes and coeliac disease under the carpet too. I'll wager a bet that if people were diagnosed and treated for sleep apnoea early on, then the NHS would save a lot of money on the other 'conditions' it leads to.
Richard Mundy said:This case has created a good deal of interest, mainly because it goes straight to the heart of 'family life', or death, as the case may be, in the most tragic circumstances.
I received a phone-call this morning from a lady in Woking whose son had recently died of sleep apnoea at the age of 43. He was on CPAP therapy and was not over-weight. He lived alone and it was the neighbours who found him dead in bed; the police called at her home at 6.00am to bring the news.
The inquest result was that he died of sleep apnoea , exacerbated by a heart condition. The poor woman is most distressed, as you can imagine, and has found it impossible to get any help or support from the established sleep-clinics that she has called. I hope I was able to put her fears to rest.
I have asked for a copy of the post-mortem report on the driver in South Wales who lost his own life as well as his son and daughter-in-law: the coroner has told me sleep apnoea did not contribute to his death.
Until sleep apnoea is swept from under the carpet, people will continue to hold on to their old ideas:'It's nothing to worry about.' - that's all very well, but if your wife or husband pokes you in the ribs during the night and says: 'You stopped breathing.', you must take it seriously, it means there is something wrong, and you must do something about it.
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Permalink Reply by Julie on
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I would like to clarify a few things so that anyone out there who is reading this thread and suspects a family member may have sleep apnoea gets the correct information.
You don't automatically lose your driving licence if you are diagnosed with sleep apnoea, it all depends on the severity after being assessed and before receiving treatment. If however you refuse to be treated after being diagnosed then your licence can be taken from you. I have sleep apnoea and my hospital told me I could continue to drive but obviously to use common sense...if you feel tired don't drive!
As for your insurance, it’s a simple matter of mentioning to your insurance company that you have sleep apnoea and providing the DVLA are happy then it won’t make any difference to the cost of your insurance.
Many people are under the impression that only over weight people suffer with sleep apnoea, in fact some time ago the BBC ran a program suggesting overweight lorry drivers had a higher probability of having sleep apnoea. This is not always the case and after speaking to the nurse at my clinic she informed me that people of all shapes a sizes from the very slim to over weight come through the hospital doors suffering with sleep apnoea and it's not restricted to over weight people. So please don't think that because your family member is not over weight that they can't be suffering with sleep apnoea.
I suppose the choice at the end of the day is if you suspect a member of your family has sleep apnoea and they do nothing about it, could you live with yourself if they took someone’s life because they couldn't stay awake while driving. I suppose the example of lorry drivers is used because they can do more damage on the road due to the sheer size of the wagons but cars are also killing machines.
Kath, please feel free to correct any statements I have made as I wouldn't want anyone to miss the point through being ill informed.
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Hi Julie
You're right, sleep apnoea is not limited to people with weight problems. It is the type 'Obstructive Sleep Apnoea' that affects in particular those whose BMI is 30+, and this is the most common form of sleep apnoea, mainly because there are so many people with weight problems these days. Many patients are referred from ENT departments where the problem may arise from deformities in the skeletal structure of the jaw or the nose. The lungs may be the issue, not allowing the correct profusion of oxygen and blood, which is vital for healthy functioning. Again, heart failure may be the cause.
You were lucky that your hospital saved you from the bureaucratic clutches of the DVLA, but strictly speaking, it's not for the hospital to make a decision on whether or not anyone diagnosed with sleep apnoea should drive. But I know they do!
The downside of this is that any sleep apnoea patient who is involved in a serious road accident, and their sleepiness is found to be the cause, if they have not notified the DVLA, they can find themselves in serious trouble. And the hospital, too. What anyone should do is go on line to: http://www.direct.gov.uk/en/Motoring/DriverLicensing/MedicalRulesFo... Download the form to notify the DVLA of their health and let them decide whether or not theyshould drive.
The DVLA will return their licence once the hospital/clinic confirms they are responding to treatment, and 99% of licences are returned.
Considering the length of time it can take to reach a consultant's diagnosis, and the time from surrendering the licence to the DVLA and getting it back, there is one measure that can considerably shorten the period of being without a licence: once you come to terms with your daytime sleepiness, and you visit your GP, before you have received your referral appointment, send your driving-licence to the DVLA with the documents from their website. By the time you get your diagnosis and have started on treatment, your licence is well into the pulleys, levers and subterrainean machinations of the DVLA. The hospital can very soon confirm you are responding to treatment, and your licence is returned.
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You are so right Mary about certain medicines contributing to and making OSA worse. Most people know alcohol does this, but don't often connect the medicine factor. A lot of people with sleep apnoea have been put on anti-depressants over the years, due to getting depressed through the sleep deprivation. Certain ones affect sleep, as do 'sleeping' pills, tranquillisers and even pain-relievers like Tramadol. Having said this, some people just have to take these drugs for their conditions - it's a case of which is the lesser of the two evils? You obviously need your pills for the bi-polar even if it does make the apnoeas worse, so don't beat yourself up about this Mary.
Mary Zimlich said:
I know I was very lucky not to have an accident driving sleepy. I would fall asleep in my therapist office and have to head to the convenience store upon leaving to get some Red Bull and 5 Hour Energy to make it home. Lucky for others on the road my truck was totaled by a drunk driver while parked beside the road. Now that I share a car I no longer have to drive when impaired (not that I had to, I chose to and it was a dangerous decision). My roommate is willing to drive me if I don't feel safe to drive. I consider myself very lucky never to have injured another person or family while on the road sleepy.
When I was diagnosed I was very much underweight and my apnea was mild. I over did it when gaining the weight back and became 40 lbs over weight. I am within 10 lbs of my ideal weight now with no improvement in my apnes. One thing that is perhaps over looked is the effect certain medicines have on AHI. My sleep doctor is convinced that the meds I take for my Bipolar disorder are at fault for my high AHI. It took me a long time to come around to that possibility. Now I believe it to be true. I always thought in terms of respiratory depression, but in fact it may be sleep architecture that is affected.
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Hi Richard
I'm afraid we are going to have to agree to disagree regarding your comments about OSA, I think being over weight can be a factor but not the whole story. I'd be interested in seeing your evidence to back up your comments. I'm not saying that some people out there who have OSA are not over weight but as I have already mentioned it takes all sorts. I have spoken to a number of people from very slim to over weight who have sleep apnoea and this was backed up by the nurse at the hospital who deals with these people on a daily basis. There are so many factors to consider and weight is only one of them. Statistics can be manipulated and there’s nothing more factual than dealing with those directly involved with patients.
My hospital did not save me from the "bureaucratic clutches of the DVLA" as you put it, they informed that I had to contact the DVLA on the morning I was diagnosed. I was asked by the DVLA to complete a form giving contact details of my consultant at the hospital where they presumably asked about my condition as I had to give permission for this. They said I could continue to drive and did not take my driving licence from me. Obviously common sense must prevail....if you are sleepy please do not drive. In fact I did not complete the form for the DVLA until the hospital had diagnosed me with sleep apnoea. Personally I wouldn't send my driving licence to the DVLA until diagnosed as until then there is no evidence that you have sleep apnoea. Out of 10 people tested on the same night as I was only three were diagnosed (two of which were slim). However that was maybe down to the fact that I can sleep anywhere and even although they placed a mask on me at 3 am in morning (because my oxygen levels were down at 72%), I was able to fall back into a deep sleep after half an hour which gave the hospital the evidence they needed that CPAP made a difference and brought down my apnoeas.
Again I would say to those people who are not sure if they have sleep apnoea, please don't think that because you are not overweight that you can't have sleep apnoea as there are so many factors that should be taken into consideration. If you are concerned that your driving licence may be taken off you then contact the DVLA and ask them what the rules are.
I fell asleep at the wheel once on a motorway for a split second before I was diagnosed. Fortunately the adrenaline rush gave me the shock of my life and I managed to pull into a service station to rest up. I didn't feel sleepy when I started on that journey but after driving for an hour I started to feel the strain. I was very fortunate but many of you may not be so lucky so if you snore loud enough to wake the neighbours and stop breathing occasionally then please get yourself to a doctor.
Richard Mundy said:Hi Julie
You're right, sleep apnoea is not limited to people with weight problems. It is the type 'Obstructive Sleep Apnoea' that affects in particular those whose BMI is 30+, and this is the most common form of sleep apnoea, mainly because there are so many people with weight problems these days. Many patients are referred from ENT departments where the problem may arise from deformities in the skeletal structure of the jaw or the nose. The lungs may be the issue, not allowing the correct profusion of oxygen and blood, which is vital for healthy functioning. Again, heart failure may be the cause.
You were lucky that your hospital saved you from the bureaucratic clutches of the DVLA, but strictly speaking, it's not for the hospital to make a decision on whether or not anyone diagnosed with sleep apnoea should drive. But I know they do!
The downside of this is that any sleep apnoea patient who is involved in a serious road accident, and their sleepiness is found to be the cause, if they have not notified the DVLA, they can find themselves in serious trouble. And the hospital, too. What anyone should do is go on line to: http://www.direct.gov.uk/en/Motoring/DriverLicensing/MedicalRulesFo... Download the form to notify the DVLA of their health and let them decide whether or not theyshould drive.
The DVLA will return their licence once the hospital/clinic confirms they are responding to treatment, and 99% of licences are returned.
Considering the length of time it can take to reach a consultant's diagnosis, and the time from surrendering the licence to the DVLA and getting it back, there is one measure that can considerably shorten the period of being without a licence: once you come to terms with your daytime sleepiness, and you visit your GP, before you have received your referral appointment, send your driving-licence to the DVLA with the documents from their website. By the time you get your diagnosis and have started on treatment, your licence is well into the pulleys, levers and subterrainean machinations of the DVLA. The hospital can very soon confirm you are responding to treatment, and your licence is returned.
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Permalink Reply by RockRpsgt on
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Interesting discussion guys. We always seem to come back to the chicken or the egg theory. I would like to add some things. Please excuse my scrambled thoughts as I am working and will be adding throughout the night.
It is a myth that OSA is a problem of just the obese. The majority of us are born and will die with apnea. This is why we use averages in diagnosing this disorder. Why you ask, Because most people have it. I have done over 1500 studies and have yet to see an AHI of 0 that was not a titration. While lifestyle will affect apnea it will more likely be the other way around. Having a BMI>30% increases your chances of having moderate to severe apnea by 6 fold. At this weight your chances for all terminal illnesses are increased not just apnea. The greatest predictors of OSA are neck, mouth, and air way size. Notice that these are all problems of anatomy and genetics.
I would also like to say that OSA is not a pulmonary function. Obstructive apnea IS a neuromuscular disorder brought on by muscle atonia. Respiratory problems will not lead to OSA or the other way around. Yes they will complicate one another such as with COPD and OSA(overlap disorder). Central apnea is a disorder caused by an error in the communication between the brain and the lungs. Central apnea always has a source whether it can be found or not. This type of apnea, not OSA, can be caused by problems with the gas exchange in the lungs.
Heart problems do not exacerbate OSA. OSA cause heart problems. Untreated heart problems and OSA will result in central apnea or a heart attack. I question any inquest resulting in death from apnea. Without having the person hooked up and monitored by the proper equipment there is just NO WAY of validating that finding. Heart attack due to complications of untreated apnea would be more proper even if tough to prove. I seriously doubt that any medical professional would list an unvalidated cause on any medical record. To date only one death has been proven to have been caused by apnea. This was at the university of Wisconsin. The person was brain dead and his last breath was a central. His wife donated her husband's last breaths to apnea research.
As for the above mentioned family I would as much attribute it to bad luck as I would anything else. I would also use this as a leason that we all need to be responsible for our own health and how it effects others. You know the saying "We can lead a horse to water......................" Above all wear your seatbelt.
We have no idea what happened in that car. The only witness was asleep.
It is a huge error to put OSA in a box or call it "simple". Sleep is the neurofingerprint of the soul. Everyone's is different and is affected by different things. Sleep is a process.
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Hi Julie,
I'm sorry if I didn't make myself clear; of course, people of all builds can develop sleep apnoea. It is not restricted to those who are overweight. Of those who are overweight and do develop sleep apnoea, however, there is a greater chance of developing Obstructive Sleep Apnoea rather than any other type. It also follows that obesity does not necessarily result in sleep apnoea
Furthermore, as a way of relating a person's 'size' to their 'fitness', the Body Mass Index (BMI) is a poor indicator since it fails to differentiate between body-fat and muscle-mass. Two men may have identical BMIs; one is a long-term couch-potato who shudders at the thought of exercise, the other works-out regularly in the gym, runs and plays sports, yet according to their BMI they are both obese, but do they both have a limited future life-span?
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Richard Mundy said:Hi Julie,
"I'm sorry if I didn't make myself clear; of course, people of all builds can develop sleep apnoea. It is not restricted to those who are overweight. Of those who are overweight and do develop sleep apnoea, however, there is a greater chance of developing Obstructive Sleep Apnoea rather than any other type. It also follows that obesity does not necessarily result in sleep apnoea"
I believe that more often than not apnea develops into obesity.RH
"Furthermore, as a way of relating a person's 'size' to their 'fitness', the Body Mass Index (BMI) is a poor indicator since it fails to differentiate between body-fat and muscle-mass. Two men may have identical BMIs; one is a long-term couch-potato who shudders at the thought of exercise, the other works-out regularly in the gym, runs and plays sports, yet according to their BMI they are both obese, but do they both have a limited future life-span?"
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