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Last Updated: Friday, 29 December 2006, 08:36 GMT
Inside Medicine: The sleep expert
Anita Simonds
Ventilation can improve life expectancy
In a series focusing on medical specialisms, Dr Anita Simonds talks about respiratory medicine, which focuses on problems associated with breathing.

Dr Simonds is particularly expert on how lung problems affect sleep.

WHAT IS YOUR JOB?

I am a respiratory physician at the Royal Brompton Hospital, London, who specialises in breathing problems which can cause respiratory failure or affect people during sleep.

Some of these individuals develop acute breathing difficulties and we treat them in our High Dependency Unit (HDU) or respiratory wards with ventilatory support.

For others, we carry out sleep studies either in hospital or at home to assess their breathing.

WHAT IS THE MOST COMMON CONDITION?

We see lots of people with sleep apnoea as it affects around 4% of men and 2% of women.

Some of the conditions we deal with are progressive, such as motor neurone disease, and the big challenge is to improve a person's quality of life and control symptoms
Dr Anita Simonds

These individuals snore and sometimes stop breathing (apnoeas) during sleep.

The apnoeas causes both their oxygen level to dip and poor sleep quality. As a consequence, people with sleep apnoea are often very sleepy during the day.

We also see children and adults who have weak breathing muscles due to muscular dystrophies and other muscle conditions.

These breathing problems are obvious during sleep and the use of small breathing machines in the home at night is very effective.

The machines include continuous positive airway pressure (CPAP) devices for those with sleep apnoea and non-invasive ventilators (NIV) for those with weak breathing muscles.

WHAT IS THE MOST COMMON PROCEDURE?

The most common procedures are sleep studies, and inpatient and outpatient provision of ventilators and CPAP machines.

WHAT IS THE HARDEST THING ABOUT YOUR JOB?

Facilities for sleep studies and the availability of home ventilatory equipment are not as widespread as they should be in the UK.

Credit: Mauro Fermariello/Science Photo Library
Medics study sleep patterns

This means clinics get ever busier!

Though at Royal Brompton we are lucky as my colleague and I will soon be joined by another consultant.

Also some of the conditions we deal with are progressive, such as motor neurone disease, and the big challenge is to improve a person's quality of life and control symptoms.

WHAT IS YOUR MOST SATISFYING CASE?

Finding that non-invasive ventilation improves the life expectancy in youngsters with muscular dystrophy, spinal muscular atrophy and related muscle disorders.

Before this many children died before they reached adulthood.

Now many are off to university and are surviving longer than previously expected. We share vicariously in their many achievements!

WHY DID YOU CHOOSE THIS SPECIALTY?

I chose respiratory medicine as I became interested in the causes of respiratory failure and how these could be reversed while working initially in anaesthetics, and then when researching different types of ventilators.

IF YOU HAD YOUR TIME AGAIN WOULD YOU CHANGE YOUR SPECIALTY?

Probably not.

My career path has been serendipitous via anaesthetics, intensive care and research into respiratory medicine.

This would be hard to reproduce today as the training schemes have changed. I am very fortunate to work with both adult and paediatric patients and carry out research in an area that can quickly be translated into improved NHS care.

HOW DO YOU SEE THE ROLE DEVELOPING IN THE FUTURE?

Treatment is diversifying in sleep apnoea.

A recent research project here showed that 50% of patients with mild heart failure have sleep apnoea and that respiratory support may improve heart function.

Also, we need to clarify the long-term role of home ventilation in patients with COPD (chronic obstructive pulmonary disease), and understand how non-invasive ventilation might ease breathlessness in a range of chronic conditions.

I hope too, that working jointly between the NHS and industry, we can help improve the design and user-friendliness of portable ventilators.

CV - Dr Anita Simonds
1979: Qualified in medicine at University College Hospital London.
1983: Began specialising in respiratory medicine
1990: Appointed consultant in respiratory medicine at Royal Brompton Hospital





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