Todays headlines

[Denny]

http://msnbc.msn.com/id/9981943/

Interesting article

[Rod]

Denny: Thanks for posting the article. We all have so much to learn. Rod..

[Colorado Jan]

It WAS an interesting article. However, I was relieved to see that it was saying that people who had CENTRAL sleep apnea and HEART FAILURE were the ones that did not live longer despite CPAP. That's a whole different thing than what the majority of us here on the board have....WHEW!

Jan in Colo.

[Morpheus]

I wasn't relieved to read this: "A seven-year study, led by Klar Yaggi of the Yale University School of Medicine, found that people with apnea were twice as likely to die or have a stroke. The risk more than tripled among volunteers with the worst apnea. The study involving 1,022 people also showed that the risk persisted even with treatment to keep the throat open during sleep, mostly through a continuous positive airway pressure (CPAP) machine."

[Colorado Jan]

Whoops, you are right. You were quoting the Yale study which didn't seem to distinguish what type of apnea their subjects had.

I was referring to the Canadian study which focused on central apnea patients.

Bummer.

Jan in Colo.

[allen]

Morpheus,
<g> I'd copied the same selection to paste here. While my primary concern has been only about simply feeling rested, it is dismaying to see that the machines don't do anything to prevent death or strokes related to apnea.

Here's the other paragraph I found interesting, if not for altogether serious reasons:

A seven-year study, led by Klar Yaggi of the Yale University School of Medicine, found that people with apnea were twice as likely to die or have a stroke. The risk more than tripled among volunteers with the worst apnea.

Okay, my question is this: Folks with apnea "are twice as likely to die" compared to what? People that aren't going to die? Hello? Do they mean "twice as likely to die at an early age," or what? What do they mean?

I'm guessing, based on the paragraph, that we are twice as likely to have strokes compared to people who don't have apnea. That's a frightening statistic. "Twice as likely" is pretty huge. That, at this point, there's nothing to do to lower those odds is not very comforting.

I can't wait to get some energy from this treatment so that I can find the oomph to get on a diet and--heaven forbid--possibly to the gym.

Allen

[Sleeper]

Especially for those of us with dubious results, wondering if the CPAP makes us feel worse..... It does give us pause for thought.

[ProfessorSleep]

News stories such as this can be startling! The Yaggi study (from Yale) established the independent link between apnea and premature death, stroke, heart disease - when UNtreated. This study did deal with OSA, rather than central apnea. The MSNBC article addresses the risks of central apnea and also for heart failure. CPAP often is prescribed for heart failure patients, and this study raises big questions about the appropriateness of that. Otherwise, I find the Yaggi study to be additional motivation to keep using my CPAP. When CPAP doesn't seem to help, though, it appears there is good reason to seek additional interventions due to the risks associated with untreated apnea of any type. At least there are studies being done now!

_________________

CPAPopedia Keywords Contained In This Post (Click For Definition): news, CPAP

[Sleeper]

I also found this article, which has a little more information:

http://www.webmd.com/content/article/115/111500.htm

[Jere]

I think that the article is written poorly. The distinction made by the reporter between regular obstructive apnea and central apnea blurs when he/she quotes the studies. As for the effectiveness of CPAP therapy, the article speaks to central apnea sufferers, but fails to discuss the efficacy of CPAP therapy for the vast majority of us who suffer from obstructive apnea.

[ozij]

I agree with Jere.

Here's some more info, from an edotrial in the same issue of the New England Journal of Medicine, re the Centrap apnea study:

In order to better appreciate the insights offered
by the CANPAP trial, it is important first to recognize the limitations of the study. Despite a careful titration protocol in treatment with CPAP, the apnea–
hypopnea index was reduced by only 50 percent, with a substantial residual apnea–hypopnea index of about 20 events per hour. At one year,
CPAP was being used for only 3.6 hours per night. Assuming seven hours of sleep time, only 25 percent of the total apnea “burden” was being relieved. Perhaps as a consequence, neither sleep quality nor arousals from sleep .

(my emphasis)
(Source:Virend K. Somers, M.D., Ph.D., "Sleep — A New Cardiovascular Frontier" Volume 353 November 10, 2005 Number 19 353;19, Editorial.)

O.

[neversleeps]

... it is dismaying to see that the machines don't do anything to prevent death or strokes related to apnea.

Do NOT believe this!!! This was NOT proven. Please read the details of this study so you are well-informed. You need to read this ENTIRE thread:

IMPORTANT New Apnea Study

It gets off topic a bit, straying from the actual subject of evidentiary discussion to fatalistic thinking, but it is important to read about the holes in this study.

The continued use of CPAP therapy throughout the course of the study was never monitored or verified. The researchers fully admit this. Some (58%) of the participants were prescribed cpap therapy at the beginning of the study. They told the researchers they used it at least 4 hrs per night, 5 nights per week when the study began. (That, alone, sends up a red flag. Would you reach a conclusion regarding the efficacy of cpap therapy based on participants who only used it half of their sleeping hours? Would you reach a conclusion regarding the efficacy of cpap therapy based on what someone SAID they did? This compliance was not verified by machine/software data; they just went by what these people told them regarding hours of use AT THE BEGINNING OF THE STUDY.)

There was NO verification or even an attempt to verify or monitor continued CPAP use by any of these people throughout the 3.4 year study. How many kept using it? THEY DON'T KNOW. THEY NEVER CHECKED. If any of the participants kept up with the therapy for the duration of the study, how many of their sleeping hours did they use it? THEY DON'T KNOW. THEY NEVER CHECKED.

Their conclusion that stroke risk was not reduced was misleading at best, negligent at worst.

[ozij]

Yaggi's study is being misquoted in the popular press.
It was not a study of therapy, and showed nothing about it's effects.
It merely showed that sleep apnea - even without any additional disease -mere sleep apnea causes strokes.

It's the popular press reporters who made the therapy an issue. The original OSA study isn't even flawed - when one trys to carry water in a sieve, one isn't using a flawed cup - one is using the wrong receptacle.

But of course, what the popular press wants is to sell more - and most people care more about therapy than about science so mentioning therapy and - furthermore - frightening people sells well.... look at the way we've been discussing these popular press reports - looking at the misreporting sites (and adds) etc.

No adds on the New England Journal of Medicine site (http://www.nejm.org) by the way. And you have to be a subsriber to read the original articles, or pay for them....
And this is how the study is summarized by the NEJM

Obstructive Sleep Apnea as a Risk Factor for Stroke and Death
The risk of stroke or death from any cause was significantly increased among patients with sleep apnea, independently of other cardiovascular risk factors. More severe sleep apnea was associated with greater risk.

Nothing about the effect or therapy. Boring. Bad copywriting...
O.

[neversleeps]

Ozij,

The study was interesting, but they completely destroyed their credibility with this statement.

Nonetheless, our study demonstrated an increased risk of stroke or death from any cause among patients with the obstructive sleep apnea syndrome despite the administration of various therapies.

If they'd just left that out....

Now some people believe the study proved cpap therapy is ineffective. It's a sad, sad thing.

[Roger...]

neversleeps hits the nail on the head with this statement:

Do NOT believe this!!!

This kind of reporting is what makes journalist look like idiots when they post something like this:

Bradley told Reuters that heart failure patients are given the machines to drive water out of the lungs and reduce the work of breathing. They also may help the heart beat more effectively.

From a science perspective, to not carefully control or demonstrate that the titration being applied as a treatment factor when it is being used as a major item in the study is terrible science. For certain if this reporter is doing anything they are making the researchers look like High School students just learning about science.

If there is anything worth while in these reports it is in the fact that people are showing interest in OSA and that might bring some careful looks at how poorly Apnea is being treated by the Sleep profession.