Short Duration OSA has higher mortality rate

A recent study that covered a set of patients over a period of 11 years has concluded that mild to moderate OSA patients whose obstructive events [Edit] were shorter have a higher mortality rate than those with longer OSA events.
https://www.medpagetoday.com/pulmonolog ... ders/75826

The study synopsis is quite interesting.

JDS74 wrote: ↑

Thu Dec 20, 2018 6:48 pm

has concluded that mild to moderate OSA patients whose obstructive events have a higher mortality rate than those with longer OSA events.

You might want to go back and reword that, since it doesn't seem to make any sense.

What I think he was getting at:

Male and female sleep apnea patients in the studied cohort who had short interruptions in breathing of 10- to 15-seconds had a roughly 31% increased risk of dying over 11 years of follow-up, compared with sleep apnea patients with longer-duration breathing lapses.

I must admit I am beginning to hate all these studies on OSA and mortality but bit the bullet and read this link.

I can't access the primary study but have read the abstract.

The study's authors speculate that how easily one is aroused from sleep by stimuli is an inherited trait, and that folks who have a low arousal threshold have shorter lasting breathing events than who have higher arousal thresholds.

Now, what I wonder is how many of these folks were able to use XPAP successfully over the duration of the 11 year follow up study? I would like to see that data.

Previous research has shown that folk with a low arousal threshold often have poor XPAP adherence rates

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5940432/

Commentary:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5940420/

So this information is pretty important.

Question is: how to get folks with a low arousal threshold to be able to use XPAP successfully, especially as their arousal threshold is problematic with the current treatment. Also, what is the best treatment for those with a low arousal threshold? Is it XPAP or something else?
A conundrum.

Arlene1963 wrote: ↑

Fri Dec 21, 2018 5:40 am

Question is: how to get folks with a low arousal threshold to be able to use XPAP successfully, especially as their arousal threshold is problematic with the current treatment.

I think I fit in to this category and I think it is one reasons that PAP therapy hasn't been a big improvement in how rested I feel. I still wake up at night, even when my AHI is low. I had hopped that being easily awaken was due to my sleep apnea, but after getting treatment on APAP, that didn't change the way I would have liked.

Stom wrote: ↑

Fri Dec 21, 2018 2:43 pm

Arlene1963 wrote: ↑

Fri Dec 21, 2018 5:40 am

Question is: how to get folks with a low arousal threshold to be able to use XPAP successfully, especially as their arousal threshold is problematic with the current treatment.

I think I fit in to this category and I think it is one reasons that PAP therapy hasn't been a big improvement in how rested I feel. I still wake up at night, even when my AHI is low. I had hopped that being easily awaken was due to my sleep apnea, but after getting treatment on APAP, that didn't change the way I would have liked.

You both raise points about low AHI that have come to interest me in the quest and work for better sleep--though it's been so long with my sleep apnea that I have no idea how I should feel. I can say I am much better now and can sit still in a recliner without nodding off easily, like before, when nothing was holding my attention. But I think sleep could be much better if I could lick the snoring problem, though it is much reduced and not causing many scorable apneas.

My sleep is much improved from my start with CPAP. From 3 hours time-in-apnea out of 7.5 hours of "sleep" I'm down to even a week with 0.0 AHI, 90 days of 0.1. In my first month (9/2015) I frequently had about 1/3 of sleep time in OA with lots of 120 second apneas (and a record OA of 255 seconds). It has been continual work and applications of ideas from experts in these forums. Silipos Gel-E-Roll to seal the mouth and enable use of the P10, wearing the cervical collar, getting the lower APAP pressure up where its needed; those were all game changers. But I'd still have occasional nights with a burst of OA--positional apneas I realized thanks again to these forums. Posts on this forum clued me in about an accelerometer source after I had thought I'd need to learn how to assemble one myself. It has shown me that OAs start coming on when I sleep within about a 60 degree arc centered on the forbidden supine position. Voila! Many zeroes after measures--those light cardboard boxes filling a knapsack on the back of my sleep vest--that keep me turned about 90 degrees and out of my red zone.

Time synchronized graphs of SpO2 data, graphs from Sleepyhead and those showing (my many) bodily accelerations and position shifts (mostly at snores) show unscored bodily movement that--graphically at least--sometimes shows greater disturbance/movement than apneas which are scored. Most of my position shifts accompany a snore or flow limitation and I think the snore triggers the moves. Of course some are some shifts for comfort, too. It begins to look like the sleep impairing culprit for me is mainly snores and the coincident-motion events that are accompanied by a significant increase in pulse rate along with sharp increase in Tidal volume.

I noted from the 2010 (older of two sleep studies, both short and of dubious value it seemed) that restless legs were mentioned. Maybe it is explanatory for me, but what little I've read about it associates those motions with pains in the legs. If I have those pains they do not trouble me at all before or after I sleep. Further, I doubt there is a connection between snores and restless legs.

I had my first visit with a practicing and teaching pulmonologist this week and he will run some breathing strength tests and wants a fresh chest X-ray after seeing some recurring drops in my SpO2 charts at some points of some nights.

Correction: That long OA was 155 seconds not 255. My old mind had 2 minutes and 35 seconds in it and put that 2 in wrong.

There is much more to good sleep than most people (including doctors) realize. Many of you have put lots of time and effort into finding the problems and perfecting solutions. How can any doctor in the typical American health care system do that kind of work with his or her patients - even if they wanted to. It is not a 15 minute problem.

Thank you all for sharing what you have learned. I'm grateful for you all.

Bookit wrote: ↑

Sat Dec 22, 2018 6:48 am

How can any doctor in the typical American health care system do that kind of work with his or her patients - even if they wanted to. It is not a 15 minute problem.

Right. Pity the patient who expects medical professionals to manage their sleep and CPAP therapy. They need to come here and learn to DIY.

Don't forget, we can't afford to pay doctors to spend more than 15 minutes with us.