Mr. Dan Smith:

I will do so. In the case of St. Joseph's, I have received a response which was passed on to another area manager and I presume something will be done. I have heard nothing in the case of St. Vincent's, however. St. Joseph's is an effective sleep clinic with a high throughput. There is a small clinic in Our Lady of Lourdes Hospital in Drogheda, a unit in Blanchardstown which cannot get beds and a very small unit in Cavan. All these additional things are coming on stream. An awareness campaign has been suggested but the problem is that it would clog up the waiting list in the absence of services. That would defeat the whole purpose of the exercise. This is why a national strategy is required.

I will explain some of the reasons children develop sleep apnoea. Down's syndrome is prevalent in one child per 1,000 and sleep related breathing disorder, that is, sleep apnoea is present in 70% to 100% of such children. They are at high risk of pulmonary hypertension, especially in cases of coincident heart disease. For neuromuscular disease, the prevalence is one in 3,000 and 42% have a prevalence for sleep related breathing disorder. It is difficult to detect clinically but it reduces life expectancy and is reversible by treatment. Craniofacial abnormalities have a prevalence of one in 7,000. Depending on the severity, the chance of individuals with this condition having a sleep related breathing disorder is up to 100%. Achondroplasia is prevalent in one in 25,000 children and has a 48% prevalence rate for sleep apnoea. Mucopolysaccharidosis is prevalent in one in 40,000 children and has a greater than 90% prevalence of sleep disorder breathing. Prader-Willi syndrome is prevalent in one in 52,000 children and has a 25% to 75% prevalence rate. These figures are from Crumlin hospital. Approximately 0.5% of children are born with sleep apnoea.

The condition has not been clinically proven beyond doubt but one or two small studies have indicated that while it is not genetic, it is hereditary. Much depends on the craniofacial build of an individual's face, particularly where the jaw line is receding. In the past, obesity was blamed for the condition and patients were told to lose weight, but an increasing number of thin people are developing sleep apnoea. As we age, the tissue in our airways grows weaker and starts to collapse and close. Sleep apnoea develops when the airway collapses completely. One can imagine the effect of this on the rest of the major organs.

One's brain goes into a total panic, one's heart starts to beat faster and one is at a high risk of stroke because snorers traditionally get a thickening of the carotid artery. All of a sudden, there is a sudden rush of blood to the head. If there is a weakness in the artery, the person will suffer a stroke. There is a big pressure on the kidneys and other organs, as well as the threat of hypertension.

Sleep apnoea is unlikely to kill a person but what it does will kill. A road traffic accident has been costed by Government agencies at €1.5 million. It is said 20% of traffic accidents are caused by sleepy drivers. There are three categories of sleepy drivers. The first is an untreated sleep disorder, the second is young aggressive male drivers and the third is professional drivers tying to hit deadlines. If that is cut in three and one life is saved, €1.5 million could be put into this programme, which would more than fund it. It does not require big bucks. It is about getting the right people together to put the strategy together. There are methods of funding these initiatives but we have to have a national strategy. It is not about money; it is about putting the brains together and getting a strategy together. It is the same for all long-term health issues. It is about putting a simple strategy together.