archangle wrote: . . . denigrate the idea that losing weight may make CPAP unnecessary . . .
Even the dramatic weight loss of bariatric surgery is not as effective a treatment for OSA as CPAP. That is why weight loss, though often a good thing for any human being when done correctly, should not be considered a primary treatment for OSA on the same level as PAP therapy.
Stubborn doctors often get that wrong and mislead patients on that point. That is why, IMO, there is often such a backlash on this board against misleading statements about weight loss--to help the patients who have been lied to by their doctors: "Ah, just lose a few pounds and everything should be fine." There is no data to support the assumption that the use of that approach is anywhere near as successful at treating OSA as PAP therapy is--even though loss of weight, done correctly, might improve the health of the patient.
I believe the statements in this 2008 bariatric-surgery study sum it up well in explaining why misleading statements about weight loss and OSA made by doctors can be
very dangerous to patients:
"Several studies have shown that OSA may persist following weight loss. . . . A very small minority of patients experienced resolution of obstructive events after sustained weight loss, and many patients continued to require CPAP therapy. Recurrence or worsening of sleep apnea has been observed following an initial weight reduction even without a concomitant weight increase. Reports that purport to show resolution of OSA in a majority of subjects do not describe how resolution was defined or if polysomnography was obtained after the weight loss. . . . Despite dramatic reductions in our patients' AHIs the overall prevalence and severity of OSA remained high. . . . Perceived resolution [of snoring] may have led many of the patients in our study to assume that their OSA had resolved and, therefore, no longer warranted treatment. Patients and physicians need to recognize that subjective resolution of snoring does not equate to improvements or cure of OSA following weight loss."
"Patients and healthcare practitioners should recognize that reliance on weight loss as a 'cure' for OSA may lead to an inappropriate cessation of CPAP therapy. Failing to recognize or treat persistent OSA may significantly impact health and quality of life." --
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2542489/
Once any patient is diagnosed OSA, it is irresponsible to consider the patient 'cured,' even for a moment, without a PSG showing an AHI below 15 (especially in supine REM, after being off PAP for at least a week) to go along with the patient's reported
complete end to excessive daytime sleepiness, in my not-so-humble opinion. Even
then, the likelihood of recurrence is high, requiring regular sleep studies for life. Just my opinion as a patient. An obese patient, at that.
But I feel strongly that scientifically unsubstantiated claims that mislead patients NEED to be denigrated loudly and persistently. It is a matter of life and death in which there is little room for myth and wishful thinking.
