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Re: Re: Re: seriousness of OSA

Posted by SGS on July 08, 2002 at 14:16:40:

In Reply to: Re: Re: seriousness of OSA posted by Kevin (in Walla Walla) on July 08, 2002 at 12:26:23:

Ok I'll clear up my position. I'm more than aware of the findings of the SHHS and the subsidiary Wisconsin cohort. OSA is linked to hypertension. I will make this as clear as I can. The studies are quite convincing about this. The findings that the risk begins to apply those with the formerly thought to be non significant AHI 0.1-4.9 is also rather disturbing. As AHI increases so to does the risk of hypertension (I did say this very thing in my previous post?). The ffect is not very strong though, compared with the risks of hypertension and stroke or cardiovascular disease or between smoking and cancers of the respiratory tracts.

What I'm less than convinced of yet is the link between OSA and other cardiovascular and cerebrovascular diseases based on the published evidence to hand. My opinion is that the SHHS will show this connection given time and given the hypertension findings already so well demonstrated.

You're point about the hypertension medication compliance issue being related to CPAP compliance is well made. CPAP will reduce AHI-RDI to zero or very near zero. Fine- but so what? Does this make people's quality of life better, do they function better cognitively, are the less sleepy during the day? Yes, but to my satisfaction only where AHI/RDI is more than 30 and where significant daytime sleepiness exists (Barbe et al 2001 Treatment with continuous positive airway pressure is not effective in patients with sleep apnea but no daytime sleepiness. Ann Int Med 134 1015-1067). And yes this is clouded by the compliance issue. But hypertension pills are probably easier to tolerate than CPAP machines strapped to your face all night.

Five studies have tested CPAP treatment for mild OSA. It works in some people, compliance is a huge issue, but it seems to be quite difficult to predict who will benefit. The net benefit to a population given this treatment seems unconvincing to me. One of the things I would like to do is work out who in this large mild group benefits the most. It's not in my study but I'd also like to see whether hypertensive mild OSA patients benefit in terms of BP from CPAP. The australian study had too few of these- but it looked as though it might work.

The dose response relationship between AHI and Motor Vehicle accidents is a bit weird in the Wisconsin cohort. Across both genders there is a dose response relationship between AHI and multiple MVAs (2.9 snorers, 3.1 AHI 5-15, 7.3 AHI>15- Young et al. Sleep 1997). But in Yes/No accidents and within the genders the picture is pretty muddy. Dose response relationships have been shown in two other studies in clinical populations with controls. They show that a mild-moderate group do not show increased risk of MVAs compared to controls or to state averages (maybe some sort of exponential type function??). It could be tah safe female drivers bringing this down (again perhaps??).

The weight loss point I fully accept- easier said than done. Our group has seen effective SDB control with weight loss (surgical intervention required- as you point out). I'm just worried about everything else that goes with obesity and the fact we're just getting so fat in parts of the western world.

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