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Re: Re: seriousness of OSA

Posted by Kevin (in Walla Walla) on July 08, 2002 at 12:26:23:

In Reply to: Re: seriousness of OSA posted by SGS on July 07, 2002 at 14:51:17:

I have to agree with Reno Tom.

The jury has been in for a few years on the association between even mild SDB and hypertension. Look at Terry Young's work with the Wisconsin Long-Term Cohort study showing an odds ratio of 1.42 for hypertension with RDI's from 0.1 to 4.9. Susan Redline's data from the Sleep Heart Health Study is showing the same pattern. Both these are huge population studies so you can factor out the effects of weight, BMI, smoking, alcohol, etc.

When you talk about CPAP being effective only with RDI's > 30 are you talking about efficacy or compliance. CPAP is effective at controlling RDI's < 5; however, compliance becomes an issue. Many of the compliance issues are related to lack of "face time" with experts in fitting/using CPAP, an over reliance on poorly trained DME's to manage the patient, and a lack of knowledge among most medical personnel that left untreated, even mild minor SDB will have subtle long term consequences, and will only worse over time.

This is the same problem we had when we began treating hypertension years ago. Those with mild minor hypertension had no outward signs/symptoms, thus they were resistent to use the initial anti-hypertensive medications because of even mild side effects. It was only when the lay public became aware of the acute and long term dangers of untreated (even mild) hypertension that medication usage and compliance began to increase.

Studies are mixed on if weight loss significantly changes with CPAP utilization. Significant weight loss, pre treatment, other than bariatric surgery, is very very rare. Probably due to the changes in the insulin response curve induced by the SDB.

Studies are also mixed on the rates of MVA's with SDB patients. None of the studies stratifies the RDI to the MVA level. I'm hoping that the Wisconsin Cohort study and the Sleep Heart Health Study will allow these questions to be answered.

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