Sleep Apnea Lecture part 2

It can be shown that if you count the number of events against the sleep/heart/health data that people report that they are more sleepy.

Sleep Disordered Breathing Events cause very dramatic changes in the sympathetic nervous system. At the moment of arrousal it has been measured that blood pressure increases, and only lasts a few seconds. What if this happened over and over? A experiment in Canada by Elliot Phillipson were he gave dogs severe sleep apnea through artificial means and what he showed was their blood pressure went up during sleeping. The question was asked what if it is just arrousals? The same thing happened. However, the ones with the apnea that were looked at during the day had elevated pressure where the ones with just the arrousals did not.

How do we put this all together into a chronic story? Well if you say Sleep Disorder Breathing has the 2 major effects of lowering your oxygen and waking you up, stimulates you into stress, that stress and several other things causes transient blood pressure rises, those transient things if repeated enough may cause chronic blood pressure rises, chronic blood pressure we know is bad for you and causes cardiovascular morbidity that is a nice way to tie it all together. Probably not this simple, and it needs to be proven, because many simple things we assumed have turned out not to be true.

So what data do we have? If you have a higher level of apnea, you have about one and a half times chance of having hypertension compared to people with lower level of apnea. Looks like associated not cause. There is very early data showing that treating it changes it.

There is a fascinating paper that came out a few weeks ago in the New England Journal that talks about the time that people die. There is a well known observation that people have a tendancy to die in the 6am - 12noon period. The sleep apnea patients died 6 hours earlier in the 12midnight - 6am period. There is a difference in the pattern, this is not conclusive but it is very suggestive that even if sleep apnea doesn't cause anything, that it picks out people that are susceptable, much as any other stress might, and therefore might be worth addressing even in those people that don't have symptoms.

Let me sumarize what I have said so far.

Sleep apnea has consequences. Those consequences include:

excessive sleepiness, but not in everyone
decrease quality of life
impaired memory
hypertension, possible heart attacks, and possible strokes
and death seems to be increased in severe sleep apnea
increased risk of diabetes
another fascinating but also early report suggests that it also might cause increased appetite.

What are the treatments?

If you are overweight it helps to lose the weight, and it doesn't always work, but it works in enough people that it is worth pursuing.

Correcting abnormal anatomy is great when we find it, but quite often we don't find it.

Upper airway congestion, you treat it.

The mainstay today though is CPAP. It works incredibly well. The problem is that patients don't necessarily use it.

There are surgeries out there, and they only work in a fraction of patients and only have a success rate of 25% and it tends to only work in people in the milder end of the spectrum.

Dental devices, that pull the jaw forward, again, logical, seems like a great idea, should have worked better than it did, does work in enough patients that we are still doing it, but doesn't work quite predictably enough to be a mainstay treatment, certainly not of severe disease.

Take home messages for 2005:

Sleep Apnea is a extremely common disease rivals diabetes and hypertension

Consequences do exist, and probably exist even for moderate sleep disorder breathing

Diagnostic tools are cumbersome, and they are really not as helpful as tradition suggests. We need new tools, and more importantly we need to prove the new approaches which are not just tools, but the way they are used, that those new approaches actually are valid and they produce useful results that will help patients and help doctors make decisions about patients.

Treatment IS effective! It is Primitive, but it does work.

Patients have taught us more than we acknowledge. Many of the improvements in CPAP have come the same way, they tell you what works.

Mikesus, thanks for taking the time and trouble to do this - very informative.
Now how do we spread the word

littlebaddow wrote:Mikesus, thanks for taking the time and trouble to do this - very informative.
Now how do we spread the word

Littlebaddow,

I believe yours is likely the most important question out there.
I attended that lecture. Since listening to the speaker and many of the audience members, I've been thinking alot about the different issues concerning sleep apnea. I came out of it even more convinced that the key to any real improvement in getting the word out may well be ourselves, the patients, and what we do with the power of patient numbers behind us. Not just as individuals, but in advocacy. And not just as a group, but being tapped into the system. Sadly, that just might mean working with the product manufacturers/marketers themselves.

As much as we hate the systems that seek only profits (i.e., the drug companies, and the medical industry), unfortunately it may well be those systems which can help deliver and get the word out. I don't like it, but it may be the reality. These are only my opinions, but I feel that the physician community (which I feel is a crutial link in getting the word out) faces its own challenges which impair their abilities to get the word out -- lack of education, lack of personal experience with OSA, fear of lawsuits, their relationships with insurance companies, etc.

But I also feel that more patients must be involved in the work of the advocacy organizations, like the American Sleep Apnea Association and others. I don't really know, but suspect that successes in major improvements, such as ADA legislation and others, were successful largely because of the advocacy of those disabled by their conditions.

Sorry for my rambling on the subject, but your question is one that's been on my mind quite a bit lately. Thank you for posing this question. Might make a good forum topic. Thanks.

Linda

When I spoke with Dr Rappaport, I mentioned the problem of patients having the problem of being dropped into the abyss after diagnosis. IE, here is your machine, have a nice day. Quite often the mask is a bad fit, and the machine is a straight pap, almost as if the providers want to set us up to fail. His response was basically what LDUYER said, we need to get together and let them know. If straight CPAP works for you that is great, but there are a lot of folks that it doesn't. As he said CPAP works quite well, but only if you USE it!!


I am going to post the Q/A session today. BTW.

Thanks for posting the lecture notes, Mike. Dr. Rappaport and Dr. Sullivan are both "outside the box" sleep science pioneers whom I deeply admire.

In another thread you echoed their views that the AHI/RDI has serious flaws as a severity indicator of sleep disordered breathing. Amen to that! Sleep science is still in its infancy, but making great leaps and strides.

Where would we be without the likes of the great sleep pioneers like Rappaport and Sullivan?

I can't help wondering how our forum could be used to help the ASAA do their job (other than the AWAKE groups).

I wonder how our voices, our concerns, our strong suggestions/demands could be organized and used to insist the ASAA and others work more closely with patients in their brainstorming and strategies for improving things. If working with the DMEs is the key, then perhaps a stronger ASAA and patient alliance might be used in some planning involvement with the DMEs. I'm only just pondering aloud. Please forgive.

Linda