Mayo considers "UARS" to be "an obsolete term."

[jnk]

"UARS . . . . An obsolete term used to define increased RERA but with AHI <5. The current definition subsumes UARS under the OSA category."--Mayo Clinic Proceedings, June 2011, page 550, Table 2 entitled "Definitions of Sleep-Related Breathing Disorders," in the article "Updates on Definition, Consequences, and Management of Obstructive Sleep Anpea," by John G. Park, MD; Kannan Ramar, MD; and Eric J. Olson, MD, in a Concise Review for Clinicians. http://enotes.tripod.com/sleep_apnea2011.pdf

[robysue]

Interesting paper.

Hypopnea is defined as "Reduction in airflow with resultant desaturation >= 4%" (which is similar to the AASM "Recommended Standard" for scoring a hypopnea)

RERA is defined as "Reduction in airflow with resultant arousal but not meeting desaturation criteria for hypopnea" (which is similar to the AASM "Alternative Standard" for scoring a hypopnea.)

So I guess under the Mayo clinic's interpretation those "78 Hypopneas with Arousal" that counted toward the RDI, but did not count toward the AHI in my sleep study, are RERAs. And with an RDI of 23.1, they'd approve of my official diagnosis being moderate OSA instead of UARS.

And, remarkably, this paper talks about the problem of adherence to the prescribed therapy rather than the more negatively loaded term of compliance. And it interestingly managed to hit all the big adherence problems without implying the patient is at fault or "failing" at CPAP. Indeed, the language used throughout is whether patients can tolerate the machine or not.

And the paper also states: "Recognizing that PAP adherence is problematic, several investigators studied the use of a soporific. .... Other means of improving adherence include the addition of humidity, intensive education, close follow-up, and treatment of nasal congestion."

How many of us receive NO real education and little or no follow-up? How many are left to figure out that they need to do something serious about nasal congestion all on their own?

[napstress]

Thanks for posting this, jnk—and to RobySue for "thinking aloud" about your own situation. Both are helping me put the pieces of my own puzzle together.

[jnk]

Thanks for posting this, jnk—and to RobySue for "thinking aloud" about your own situation. Both are helping me put the pieces of my own puzzle together.

It may be the best thing I've read in a while, as far as an up-to-date summary of present thinking. And yes, Robysue's comments were very interesting.

Some of my favorite statements in the article:

"Diagnosis of OSA usually requires overnight polysomnography . . . A negative result from a portable monitor does not necessarily rule out OSA."

On "overnight oximetry" as "a surrogate for PSG":

"Because of its low specificity, further testing is required for sleepy or otherwise symptomatic patients with a negative oximetry result."

Other stuff:

"The CPAP device is still the criterion standard for the treatment of OSA. . . . The machines are much smaller and quieter . . . , less than whisper-quiet conversation."

"AASM suggests bilevel PAP be used when CPAP pressure exceeds 15 cm H2O."

"Positional therapy is another option for those who experience mild OSA predominantly while sleeping on their back. . . . Although such an approach may be effective temporarily, overall adherence has been disappointing. . . . Positional therapy . . . may be acceptable as an adjunctive or secondary therapy option in those who have respiratory events predominantly in the supine position only."

[Italics mine above.]

"Some . . . with CompSAS can eventually be treated with CPAP . . . Up to 50% will require the use of [ASV]."

[rested gal]

Very interesting article, Jeff. Thanks so much for the link.

[mars]

JNK Wrote
Mayo considers "UARS" to be "an obsolete term."
Postby jnk on Tue Oct 25, 2011 4:16 pm

....the article "Updates on Definition, Consequences, and Management of Obstructive Sleep Anpea," by John G. Park, MD; Kannan Ramar, MD; and Eric J. Olson, MD, in a Concise Review for Clinicians.
http://enotes.tripod.com/sleep_apnea2011.pdf

Some of my favorite statements in the article:

"Positional therapy is another option for those who experience mild OSA predominantly while sleeping on their back. . . . Although such an approach may be effective temporarily, overall adherence has been disappointing. . . . Positional therapy . . . may be acceptable as an adjunctive or secondary therapy option in those who have respiratory events predominantly in the supine position only."

[Italics mine above.]

Well, JNK. I see you are still trying to mislead the members of this Forum.

The above quote is a combination of the following two separate extracts from the paper.

Positional therapy is another option for those who experience mild OSA predominantly whilst sleeping on their back. This approach uses a barrier, such as a body pillow or a tennis ball in a t-shirt, to prevent supine sleep. Although such an approach may be effective temporarily, overall adherence has been disappointing.

Positional therapy (in which some barrier is used to minimize supine sleep) may be acceptable as an adjunctive or secondary therapy option in those who have respiratory events predominantly in the supine position only."

And so we get quite a different meaning from the one you falsified above.

The statement in your quote

Although such an approach may be effective temporarily, overall adherence has been disappointing

is made to appear to be talking about Positional Sleep Apnea Therapy. Whereas it came from the statement about barriers used in positional therapy, and barriers is what it is talking about., not Positional Sleep Apnea Therapy.

Barriers are not mentioned in your quote.

Once again you are trying to disparage Positional Sleep Apnea Therapy, and this time you are being even more blatantly dishonest than we have come to expect.

I note what you said the last time you were exposed as a liar and misinformer -

Re: Update - Positional Sleep Apnea Therapy

Postby jnk on Thu Sep 29, 2011 9:50 am

Thanks, Mars.

Points taken.

I wish you all the best with your various treatments for various conditions.

-Jeff

So the above is just hypocrisy. Obviously you did not get it, as you are still trying to mislead people, this time by presenting false quotes as genuine.

Mars

[jnk]

The latest from the AASM, to the best of my knowledge, on positional therapy is found at http://www.aasmnet.org/Resources/clinic ... Adults.pdf :

"Positional therapy, consisting of a method that keeps the patient in a non-supine position, is an effective secondary therapy or can be a supplement to primary therapies for OSA in patients who have a low AHI in the non-supine versus that in the supine position. Because not all patients normalize AHI when non-supine, correction of OSA by position should be documented with PSG before initiating this form of treatment as a primary therapy."-- "Clinical Guideline for the Evaluation, Management and Long-term Care of Obstructive Sleep Apnea in Adults," Journal of Clinical Sleep Medicine, Vol. 5, No. 3, 2009.

(Underlines are mine.)

Studies showing potential benefits from an approach are not the same as published clinical guidelines based on the evidence obtained from large-scale proof of the validity of a treatment approach in practice.

That said, I look forward eagerly to seeing any posts of any pdfs of clinical reports from members diagnosed moderate-to-severe OSA that then document normalized AHI obtained solely from any form, or combination of forms, of positional therapy, in harmony with the guidelines above that make clear that for optimal therapy, normalized AHI is vital.

I also would like to thank all for their spirited participation in this forum and welcome all comments in threads that I initiate.

[mars]

Hi Everybody

Jnk has his admirers (and who could not help but admire such an audacious and persistent individual). One of them sent me this link, assuring me that jnk really is a good honest upright fellow, but sometimes........................................

Well - you will see -

https://www.youtube.com/watch?v=UqkeemU7fyk

and I am told that it is in these moments that jnk has the compulsion to misinform.

So now we know, and I am sure that from now on we will excuse his lapses from honesty, and his friends can no doubt expect to be betrayed again. Let us be humbly thankful that we too are not afflicted so.



Mars

[avi123]

Mars, be careful because JNK is one of the informal commanders of this COMMUNITY.

[BlackSpinner]

Mars, be careful because JNK is one of the informal commanders of this COMMUNITY.

Avi this thread is a couple of years old. Go and take your meds.