Mild, Moderate, Severe OSA -- Bogus Classifications?

rested gal wrote:

-SWS wrote:
Terrible compliance rates when prescribed CPAP -- yep. More often than not, imho, that can be attributed to mask problems.

Failed treatment with CPAP? The mask, the mask, the mask.

#1 is certainlyThe Mask but I think a close second is the lack of any knowledgeable followup and understanding of the problems we will encounter and the feeling of abandonment at a very critical period. If I hadn't found this forum to guide me we would have definitely been in the non-compliant group.

Guest wrote:Well for those just complaining about this, how about laying out what medical qualifications should require someone to use CPAP.

This is a common discussion technique for trying to paint the opposing view as invalid. So, no one's allowed to yell "FIRE!" unless they are a fireman?

Do you know how to fix your air conditioner? If not, would you refrain from saying "my air conditioner doesn't work anymore"?

Do you know how to set a broken bone? If not, would you refrain from saying, "my leg feels like it is broken"?

Do you know how to write an operating system? If not, do you always refrain from saying, "Windows sucks"?


I don't know who you are, but if you have an ounce of intelligence, you will know that the medical qualifications leading to treatment could not be determined on a board such as this. It probably requires medical research. The medical community thinks they have done this already with the AHI=5 criterion, but I say it's time to revisit that. Without being able to fix it, I can certainly identify that it is broken. Do you not think you have the same ability to determine when your air conditioner or leg is broken, even if you can't fix them?

rested gal wrote:

-SWS wrote:One question I have is to what extent aggregate management of contributing factors (weight, sleep position, rhinitis, mandible, etc.) can be a viable FIRST line of treatment in some SDB patients.

For some, yes.

While Dr. Littner spoke about weight, sleep position, and rhinitis, I think he reserved mandibular advancement dental devices to the category he had CPAP and surgery in

Rested Gal, thanks for highlighting that. Unfortunately I didn't make myself clear enough, in that what you have quoted above is MY OWN conjecture/logical-reorganization rather than a summary of Dr. Littner's views. Mandibular Advancement Devices are very easy to try. And aggregate treatment methods seem to be empirically unexplored in epidemiology.

However, for the sake of clearer context regarding Dr. Littner's views, here's a link to his white paper expressing those alternative-treatment views quoted earlier in the thread:
Mild Obstructive Sleep Apnea Syndrome Should Not Be Treated.
Dr. Littner is a UCLA medical professor who is talking about mild cases of OSA. I think it's healthy for the still-immature field of sleep medicine when doctors and scientists express views that question or even oppose current consensus.

We can happily and respectfully disagree on one point. I personally don't think these three treatments deserve non-empirical dismissal as peashooter methods of treating mild cases of apnea: 1)weight loss, 2) positional therapy in patients with supine OSA, and 3) nasal corticosteroids in patients with allergic rhinitis. I think an empirically-based jury has yet to convene---at least with respect to meta-analysis of the mild cases to which Dr. Littner refers. And considering the litany of problems that people have with sleep-adaptation to CPAP---not limited to masks---those alternate treatment methods are going to be superior to CPAP in some unknown percentage of mild sleep apnea cases at the very least. Weight loss via bariatric surgery or diet is known to eliminate apnea in more severe cases of obesity.
viewtopic.php?f=1&t=53485&st=0&sk=t&sd=a&#p495961

Open up those troublesome nasal passages and let the tongue/soft palate do ...whatever. After all, we're talkin' about people who have only mild/moderate sleep apnea. Surely the mild/moderate AHI'ers who happen to have allergic rhinitis couldn't possibly have something else, too, could they? Surely they wouldn't have BOTH allergic rhinitis AND something untoward happening farther south in the airway... like somewhere down around the vicinity of the back of the tongue. Right?

Well, Starling Resistor modeling shows that increased nasal resistance facilitates a suction-type (transluminal) collapse or downward sagging in the pharyngeal area. Not everyone is particularly susceptible to that airway-collapse dynamic, but I sure am! If I progressively and very slowly pinch my nostrils closed, I can feel my upper airway just as progressively closing to a point of pharyngeal blockage. Those are the same dynamics that occur when a paper straw collapses while drinking an overly-thick milk shake. Those same high nasal-resistance dynamics---in much less severe proportions than my experiment---are probably sufficient for RERAs and/or microarousals in certain patients. And those same suction-type dynamics are what account for the majority of discussion in these links I presented earlier. Additional Starling Resistor references:
http://scholar.google.com/scholar?hl=en ... =&as_vis=0
http://erj.ersjournals.com/content/32/1/3.full

All that said, I also happen to be of the view that CPAP is the best first-line of treatment in most cases. However, I still suspect that some doctors fail to even propose Littner's recommendations when patients with mild/moderate OSA fail CPAP.