Posted by technician on May 31, 2002 at 07:45:19:In Reply to: Comments Solicited on these 3 Journal Abstracts posted by writermd on May 13, 2002 at 07:21:14:
On # 1: Administering oxygen alone may help in the short term, but as the RDI is not decreased, the sleep disturbance can be expected to progress in severity, e.g. lengthening apneic/hypopneic events with prolonged and deepening desats. With cessation of ventilation, hypercapnia can be expected to continue to occur. This, and the resultant pH changes in the blood will continue to stimulate the respiratory drive, terminating apneas. In severe OSA patients, the repeated respiratory crises include a gasping hyperpnic hyperventilatory phase, followed by an apnea with an inital central phase during which muscle tone is decreased, setting the stage for more complete airway obstruction. I feel that, as in COPD, progressive desensitization of the ventilatory drive to hypercapnia can be exacerbated by subtle overadministration of O2 therapy. I would expect that the patients who showed improvement in subjective symptoms and demonstrated "effective relief of OSA-related symptoms" will return before long to having complaints of EDS, HTN, and cardiac arrhythmias.
On # 2, I have no comment.
On # 3: As I observe otherwise healthy and fit young adults come through the sleep lab with OSA, I am always mindful of the fact that many in my ("boomer") generation had tonsillectomy/adenoidectomy procedures done as children, in the days when these procedures were more commonly done as therapy for myriad childhood ills. I suspect that many more of my generation would be suffering OSA symptoms than there are today because of this, and that many younger sufferers are right where we would be pathophysiologically, because these structures remain in their airways as they approach middle-age. Many complain that they have had snoring and sleep disturbance all their lives, and I always wonder at the lost sleep, etc., that could have been avoided if they'd had a T&A done as a child, like I did. There is no doubt in my mind that many subjects would show marked improvements or complete alleviation of symptoms, if T&A were performed on them.
All comments are acknowledged to be conjectural, speculative, and based on anecdotal occurrences.
Thank you for the questions.
- Re: Comments Solicited on these 3 Journal Abstracts John Hey MD 20:31 6/21/02 (0)