12 Year old study claims "Mild OSA should not be treated." Thoughts?

bombayone wrote: ↑

Thu Jul 25, 2019 9:50 am

All: Please lighten up. I volunteer to be burned at the stake.

While do you feel that it's OK for you to make dishonest comments, and then when you are called on it, tell others to lighten up?

palerider wrote: ↑

Thu Jul 25, 2019 12:47 am

elavi001 wrote: ↑

Wed Jul 24, 2019 4:17 pm

Here is the study:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2564770/

What do yall make of this? Has there been any further discussion on this since 2007?

My diagnosis had 7.1 AHI so this feels important to me.

1. IT'S NOT A STUDY, it's an OPINION piece by one idiot. At the bottom "I conclude" Don't you people ever read anything before posting?
2. It's been refuted. Read the studies that are listed on the side under 'cited by other articles in PMC' For instance "Of note, our results showing that there is an increased risk of CKD even in patients with mild OSA may be of particular importance, as there has been disagreement regarding treatment for patients with mild OSA [47, 48]. Thus, our result may present a different perspective on the clinical management of patients with OSA." (47 being the opinion piece you referenced).

Stop grasping for reasons not to treat yourself and have a better life.

iI don't think the KID has learned how to spell ASSume! Jim

Insurance company financed, no doubt.

elavi001 wrote: ↑

Wed Jul 24, 2019 4:17 pm

Here is the study:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2564770/

What do yall make of this? Has there been any further discussion on this since 2007?

My diagnosis had 7.1 AHI so this feels important to me.

Your intuition is correct. To be scored in the AHI, a breathing event has to awaken the patient. In your case, an AHI of 7 would mean you were awakened 49 times in 7 hours of sleep. Yep, it's important to avoid that.

Pugsy wrote: ↑

Thu Jul 25, 2019 7:49 am

Dog Slobber wrote: ↑

Thu Jul 25, 2019 7:27 am

You're so desperate to be a hero around here you make up crap so you can swoop in to fight enemies that aren't there.

He doesn't seem to understand that his self appointed feel good moderator status doesn't hold much water here.

foe him and forget him.

elavi001 wrote: ↑

Wed Jul 24, 2019 4:17 pm

My diagnosis had 7.1 AHI

A very large study (The Hypnolaus Study) done within the last 5 years indicated that the majority of middle aged and older adults they tested had sleep disordered breathing and at least mild sleep apnea.

The median AHI in that study was 6.9 for women and 14.9 for men.

I strongly suspect this is the reason why the Canadian recommendation is to only treat moderate and severe OSA. It would be extremely costly if we treated everyone with mild OSA through government health care programs. Sad but true. It comes down to dollars.

zonker wrote: ↑

Thu Jul 25, 2019 1:40 pm

foe him and forget him.

Oh....make no mistake....my Foe list is fairly massive but most aren't active here anymore. I keep people on it forever just in case they ever come back needing help from me.

Unfortunately part of my "job" here is to sort of diffuse volatile situations if they happen here and that involves sometimes reading stuff that people on my foe list might have said.
And of course I have no real choice if someone quotes them.
So I hold my nose when I have to read it.

Pugsy wrote: ↑

Thu Jul 25, 2019 1:56 pm

zonker wrote: ↑

Thu Jul 25, 2019 1:40 pm

foe him and forget him.

Oh....make no mistake....my Foe list is fairly massive but most aren't active here anymore. I keep people on it forever just in case they ever come back needing help from me.

Unfortunately part of my "job" here is to sort of diffuse volatile situations if they happen here and that involves sometimes reading stuff that people on my foe list might have said.
And of course I have no real choice if someone quotes them.
So I hold my nose when I have to read it.

understood. but for me, concern trolling is prolly the worst. so *I* get the luxury of not reading some posts.

Pugsy wrote: ↑

Thu Jul 25, 2019 1:56 pm

zonker wrote: ↑

Thu Jul 25, 2019 1:40 pm

foe him and forget him.

Oh....make no mistake....my Foe list is fairly massive but most aren't active here anymore. I keep people on it forever just in case they ever come back needing help from me.

Unfortunately part of my "job" here is to sort of diffuse volatile situations if they happen here and that involves sometimes reading stuff that people on my foe list might have said.
And of course I have no real choice if someone quotes them.
So I hold my nose when I have to read it.

Thanks for the lengthy discussion and explanation. A simple Thank you would gave sufficed.

bombayone wrote: ↑

Thu Jul 25, 2019 3:47 pm

Thanks for the lengthy discussion and explanation. A simple Thank you would gave sufficed.

Just in case you didn't notice...I wasn't talking to you.

Will be a cold day in hell when you get a thank you from me unless it is when you decide to go annoy someone else on another forum.

Knock off the passive aggressive crap.... I see it for exactly what it is.

bombayone wrote: ↑

Thu Jul 25, 2019 9:50 am

All: Please lighten up. I volunteer to be burned at the stake.

I'm sure the good people of this forum would happily chip in for some diesel fuel to get the fire started to get rid of you.

Arlene1963 wrote: ↑

Thu Jul 25, 2019 1:45 pm

I strongly suspect this is the reason why the Canadian recommendation is to only treat moderate and severe OSA. It would be extremely costly if we treated everyone with mild OSA through government health care programs. Sad but true. It comes down to dollars.

And yet sleep apnea leads to further health problems. They would save more money in the long run if they helped to prevent more serious health problems.

zoocrewphoto wrote: ↑

Fri Jul 26, 2019 2:53 am

Arlene1963 wrote: ↑

Thu Jul 25, 2019 1:45 pm

I strongly suspect this is the reason why the Canadian recommendation is to only treat moderate and severe OSA. It would be extremely costly if we treated everyone with mild OSA through government health care programs. Sad but true. It comes down to dollars.

And yet sleep apnea leads to further health problems. They would save more money in the long run if they helped to prevent more serious health problems.

The long term view is unfortunately often a casualty when it comes to provincial governments and health care spending.

12 Year old study claims "Mild OSA should not be treated." Thoughts?

Bad title, but some kernels of truth within, if you sift out the chaff.

The diagnosis of mild OSA is not well defined.

True. Self-judgments of sleepiness are subjective, and sleepiness may be caused by factors other than measured breathing disturbance. One night's measured AHI may not say much about the overall situation of sleep-breathing for any person.

Although there are many studies that address treatment of OSA, relatively few focus on mild OSA.

True. This is true of most studied conditions, in that mild presentations are always more difficult to define and study.

In addition, there are several potential treatment modalities.

True. People with mild SDB are often considered to have more options than CPAP, since for some of them CPAP can disturb sleep more than it can help it. That is what makes the context of the wording of the opinion so important:

For purposes of this review, continuous positive airway pressure (CPAP) will be the main treatment comparator.

THAT is the crucial statement for filtering out the noise inherent in the "review." The other statement that follows that one makes that filter even more focused:

Interventions such as attempted weight loss, sleep position, sleep hygiene, etc. will be considered part of usual care and not specific treatment of OSA.

Those two statements taken together define what the author means by "treatment" of OSA, according to the author's personal take. It is a valid take, though it makes the entire work confusing by stepping outside of normal parameters of defining treatment.

The author then makes an interesting argument by pointing to statements on BP and heart rate as made by studies referenced in an AASM opinion on CPAP initiation:

“The sole study that examined change in blood pressure associated with treatment in milder OSA using a tablet placebo failed to show differences between CPAP treatment and placebo. The 2 Level II studies that evaluated the impact of CPAP versus placebo on heart rate produced conflicting results."

Although it is not the point being made by the author, I would point out that BP and heart rate are perfect examples of other conditions that need considerable data and judgment and reasoning when it comes to when to mention, suggest, or push treatment for milder presentations. Multiple measurements over time establish when issues of BP and heart rate are significant enough to start suggesting someone may want to begin considering treatment options for BP or heart rate issues. That model for an approach, however, is not really possible or practical with mild OSA treatment decisions, since measurements of sleepiness and AHI are not as easy or as clear as are the measurements of BP and heart rate.

Apart from the difficulty in documenting improvement with CPAP in mild OSA, the issue of acceptance and adherence should be taken into account. . . . Patients with mild OSA are not usually improved by PAP treatment and even if improved are not likely to be adherent.

True. It can be much more difficult for someone to be adherent when improvements are not immediately obvious either to patient or to clinician. Those of us on this board with moderate-to-severe OSA may tend to forget that sometimes, especially when we are ones who saw immediate and obvious improvement upon initiation of PAP therapy. It is worth remembering the wide range of severity that all fall under the broad OSA umbrella.

My personal position is that assessment of milder SDB is all about giving a patient the opportunity to try PAP whenever said patient is qualified to do so in the eyes of payers. Those with an AHI above 15 or so should be strongly encouraged to give PAP the full shot, since the evidence is high for long-term benefits. But below that AHI, it is more about improving sleep in general and overall safety and quality of life in a way that may make it less-than-useful to pressure a patient into using PAP by guilting or shaming the patient. It becomes a judgment call. Patients should have choices, especially when it comes to the milder presentations of the more difficult to define conditions. They should be given opportunities to improve quality of life, not automatically forced into a treatment just because of barely crossing a line into the area of "may possibly benefit from treatment." This is true of MOST medically-defined conditions, not just OSA.

Hey, just me.

I feel very fortunate that I was diagnosed and treated for my moderate OSA.

As one of the lucky ones, I experienced results very quickly once I got over the psychological resistance to using CPAP. In my case CPAP has been perfect treatment.

So I put myself into the OP's shoes and honestly have to wonder ... if I were diagnosed with mild OSA and after a year of giving CPAP a try still felt like crap (or actually worse than before treatment) would I continue based on the faint hope of improved health outcomes somewhere down the line?

I can see why frustration sets in. So I think it is perfectly normal to seek out advice and to ask this question as the OP has done, many would be wondering the same thing. Not experiencing tangible improvements is very frustrating. It is probably at the heart of why this treatment is so difficult because it can take lots of time in some cases, and unfortunately CPAP is not a magic bullet. And sometimes OSA/SDB might not be the reason for the symptoms either. Not easy.