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Re: Long-term health Qs

Posted by SGS on January 06, 2005 at 12:59:19:

In Reply to: Long-term health Qs posted by Djabiuk on January 06, 2005 at 06:48:16:

In the Wisonsin cohort those with an RDI greater than 15 had about 3 times the risk of having hypertension after 4 years even if they didn't have high blood pressure for a start (after adjustment for other known risks etc). It's tough to extrapolate out to a person with an RDI of 80 because so few people have that bad sleep disordered breathing. Probably (conservatively) it means that you have about ten times the risk of developing high blood pressure in the next 4 years compared to somebody with an RDI of 0. (see Peppard et al. New Eng J Med 2000). The same sort of pattern probably also holds for symptomatic cardiovascular disease and mortality.

The problem is what can you do about it? CPAP would probably be any clinicians first choice with your extremely high RDI. However it's really not known what to do with the large numbers of people who have bad sleep disordered breathing but no daytime sleepiness. One trial tried to treat people with bad sleep disordered breathing (RDI>30) but no daytime sleepiness with CPAP but could not find any improvements after 6 weeks of treatment (see Barbe et al Ann Internal Med 2001).

In the population based studies it's actually very common to find people with sleep disordered breathing but no daytime sleepiness (see Young et al. New Eng J Med 1993). More common in fact than people with both. The problem is you never hear from these asymptomatic individuals unless their bed partners complain enough. Moreover the risks of cardiovascular disease apply with equal weight to them regardless of sleepiness (see Shahar et al. Am J Respir & Crit Care Med 2001) but we don't really know how to treat them yet.

Having said that CPAP is the best bet. It will resolve your sleep disordered breathing if you wear it. It will probably decrease your odds of developing hypertension and/or dying if you wear it (although there is not great proof of this yet). Losing weight will probably reduce the severity of your RDI but probably won't entirely eliminate it. However given that currently it's thought (much like cigarettes) that every RDI unit (over time mind) adds to your risk losing weight is certainly a good idea.

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