lose-weight-before-trying-cpap-sleep-apnea-treatments

[Todzo]

http://www.npr.org/blogs/health/2013/09 ... treatments

[chunkyfrog]

I was unable to lose weight before CPAP; afterward, still difficult, but doable.
What scares me the most is that stuff like this may be used to remove cpap from insurance coverage.

[BlackSpinner]

One of the worst articles I have read on the subject.
The comments have better info in them for a change.

[zoocrewphoto]

Considering that most people have difficulty in losing weight, AND sleep apnea is the reason that some people are overweight, WHY would we want to discourage people from using cpap for months and years while they struggle to lose weight?

[BlackSpinner]

Considering that most people have difficulty in losing weight, AND sleep apnea is the reason that some people are overweight, WHY would we want to discourage people from using cpap for months and years while they struggle to lose weight?

One of the commenters asked if they would give the same advice to people with diabetes - Get your weight down and we will talk about insulin.

[DoriC]

One of the worst articles I have read on the subject.

+1 I don't think this is the kind of bad information we need floating around this forum. It certainly can't help the newly diagnosed who are still in the denial stage and looking for any excuse.

[Goofproof]

Capital idea, ignore sleep apnea, loose weight, hopefully BEFORE you die in your sleep. Great Plan! Jim

[Todzo]

I was unable to lose weight before CPAP; afterward, still difficult, but doable.
What scares me the most is that stuff like this may be used to remove cpap from insurance coverage.

Me too.

I think we should all send an e-mail to the author and to NPR!

[archangle]

This article will kill people.

God help us if the government, medicare, or insurance companies read this crap.

[Janknitz]

Here's the original guidelines and their rationale published by the American College of Physicians. . http://annals.org/article.aspx?articleid=1740756

Among the interesting findings:

Moderate-quality evidence showed that CPAP was more effective than control or sham CPAP. However, no randomized trials evaluated the long-term clinical outcomes of CPAP use, such as death or cardiovascular illness, and evidence showing the effect of CPAP on quality of life was inconsistent and therefore inconclusive. Data to determine the comparative efficacy of most CPAP modifications were insufficient; however, moderate-quality evidence showed that fixed and auto-CPAP have overall similar efficacy and adherence despite small differences, and low-quality evidence showed that C-Flex and fixed CPAP were similarly efficacious.

.

This is why insurers won't pay extra for autopap vs CPAP or for "bells and whistles" like flex.

It does NOT say that weight loss should be tried BEFORE CPAP. It says that weight loss should be recommended in obese OSA patients along WITH CPAP, and if a patient cannot tolerate CPAP, then an oral device should be tried. There are three 3 recommendations of equal weight--they are not progressive steps:

Recommendation 1: ACP recommends that all overweight and obese patients diagnosed with OSA should be encouraged to lose weight. (Grade: strong recommendation; low-quality evidence)

Obesity is a risk factor for OSA, and evidence showed that intensive weight-loss interventions help reduce AHI scores and improve OSA symptoms. Weight loss is also associated with many other health benefits other than for OSA. Other factors, such as alcohol and opioid use, may be associated with adverse outcomes in patients with sleep apnea, but these factors were not addressed in the evidence review.

Recommendation 2: ACP recommends continuous positive airway pressure treatment as initial therapy for patients diagnosed with OSA. (Grade: strong recommendation; moderate-quality evidence)

In patients with excessive daytime sleepiness who have been diagnosed with OSA, CPAP is the most extensively studied therapy. This treatment has been shown to improve ESS scores, reduce AHI and arousal index scores, and increase oxygen saturation. However, CPAP has not been shown to increase quality of life. Evidence on the effect of CPAP on cardiovascular disease, hypertension, and type 2 diabetes was insufficient. Studies have evaluated various alternative CPAP modifications. Fixed and auto-CPAP, as well as C-Flex, have similar adherence and efficacy. Data were insufficient to determine the comparative efficacy of other CPAP modifications. Greater AHI and ESS scores were generally associated with better adherence to CPAP.

Recommendation 3: ACP recommends mandibular advancement devices as an alternative therapy to continuous positive airway pressure treatment for patients diagnosed with OSA who prefer mandibular advancement devices or for those with adverse effects associated with continuous positive airway pressure treatment. (Grade: weak recommendation; low-quality evidence)

Evidence showed that MADs have been used as an alternative to CPAP for treatment of OSA. Patients had AHI scores between 18 and 40 events per hour. Evidence to suggest which patients would benefit most from MADs was insufficient. However, MADs can be considered in patients with adverse effects or for those who do not tolerate or adhere to CPAP.

And before anyone gets their knickers in a snit about some of the things, the paper is careful to say evidence is "inconclusive" or "insufficient" about many things we recommend here like auto vs fixed, humidification, nasal vs FF masks, etc. What this shows more than anything else is that there are not a lot of good studies on which to form conclusions. It doesnt mean those dont help, it means the studies have not been sufficient to show the benefit. Which I find a bit disconcerting. I'd like to know that CPAP has a positive outcome in preventing some of the problems caused by OSA.

[Todzo]

Here's the original guidelines and their rationale published by the American College of Physicians. . http://annals.org/article.aspx?articleid=1740756

Among the interesting findings:

Moderate-quality evidence showed that CPAP was more effective than control or sham CPAP. However, no randomized trials evaluated the long-term clinical outcomes of CPAP use, such as death or cardiovascular illness, and evidence showing the effect of CPAP on quality of life was inconsistent and therefore inconclusive.

I honestly do wonder if the LONG TERM studies were held at bay by those in the industry who were frightened by the first looks (approximately 2006) into how much adherence (usability) there is to xPAP long term.

Note: One study reported adherence (usability) was only 17% at the one year mark.

What this shows more than anything else is that there are not a lot of good studies on which to form conclusions. It doesnt mean those dont help, it means the studies have not been sufficient to show the benefit. Which I find a bit disconcerting. I'd like to know that CPAP has a positive outcome in preventing some of the problems caused by OSA.

I have been getting the feeling for some time that the xPAP industry is indeed shooting itself in the foot by preventing the research we desperately need to - find out what is really going on in terms of how people use xPAP - find out what the problems are so that finally we can actually address the problems and move toward getting Obstructive Sleep Apnea well treated.

I think we should all write letters to our congressmen concerning getting the studies we need to sort this out and I think we should do this soon!!!

[BlackSpinner]

I have been getting the feeling for some time that the xPAP industry is indeed shooting itself in the foot by preventing the research we desperately need to - find out what is really going on in terms of how people use xPAP - find out what the problems are so that finally we can actually address the problems and move toward getting Obstructive Sleep Apnea well treated.

I think we should all write letters to our congressmen concerning getting the studies we need to sort this out and I think we should do this soon!!!

So just how are they going to do long term studies ethically? Are you volunteering to do without cpap therapy for a few years to see if you deteriorate? I am sure not.

[Janknitz]

So just how are they going to do long term studies ethically? Are you volunteering to do without cpap therapy for a few years to see if you deteriorate? I am sure not.

It would be easy enough to use non-compliant people as the control group. There's certainly no shortage of them

[emt_271]

My sleep doc answered that question with" Even if you were in olympic trim you would still have floppy airways" when I tried to avoid the hose. Now after being on it for a year I'm still fat, but not in danger of all the things we are too familiar with. I really like how my Doc thinks.

[BlackSpinner]

So just how are they going to do long term studies ethically? Are you volunteering to do without cpap therapy for a few years to see if you deteriorate? I am sure not.

It would be easy enough to use non-compliant people as the control group. There's certainly no shortage of them

But you can't do double blind studies. You can only do long term population studies and you need very similar people in your non compliant group as well as a control group who was tested for OSA and don't have it. Your best bet would be to make sure all participants have NO diabetes, heart conditions, or obesity since all of those would be complicating factors. Good luck on that.