IMPORTANT New Apnea Study

I am still waiting for an email from the researchers. At least they made distinctions between OSA and CSA. If a CPAP his helpful for many ailments including heart failure in patients with OSA, I bet it would help prevent strokes also. Nether study was conclusive or convinced me to give up my CPAP.

BTW, I buy all of my products from CPAP.com.

CPAP.COM's first celebrity endorsement!

If I may oversimplify this all, which is something I am usually known to do, and have gotten pretty damn good at, if I do say so myself, what does this do for us except stress us out more and make us get upset over something we couldn't change if we wanted to? If the bottom line is that we're at greater risk as OSA sufferers for strokes, etc., there isn't a damn thing we can do to change it.

It's almost like having to make the decision to do a full body scan or not. You may find out some things that are wrong with you that you can't change, so do you do it just for the sake of knowing it's there, although with body scans, there is also the chance one can find something that is perhaps in the early stages and can be fixed; hence, the reason for the second word in this paragraph, "almost."

Do you really want to know something like that when there isn't a thing you can do to stop it? I, the oversimplifier that I am, believe in destiny and that your fate is already written by the time you're born. I believe you have a path mapped out for you and nothing you do on this beautiful earth will change it. I'm not saying go run out into an expressway with cars doing 80 mph and not expect to die. Tempting fate is not a great suggestion. But I don't see how this information can do anything but scare us. I truly believe that sometimes ignorance is bliss.

I'm 41 and my wife and I went to upgrade my life insurance, but the company found out I've recently gone on CPAP and denied my upgrade as well as increased my current premium. My agent said that sleep apnea, whether treated or not, adversely rates a policy in the same vein as a 2-pack/day cigarette smoker. I'd like to see more positive studies done about CPAP success.

Lori, you make a great point, and everyone has their own way of dealing with information like this. I, however, am not a believer in predestination, but someone who believes we make our own destiny, to some extent anyway. I may be totally wrong, but who knows the answer on this anyway. So my reaction is to take a study like this and see it as good reason to remain on CPAP and make other lifestyle changes that *might* help the situation. I also know that medical research is fraught with limitations, so when my "control my own destiny" reaction fails to work, I read the original studies and find all the flaws.

Then I go about my merry way doing what I know I should be doing anyway - like more exercise, better diet, etc. And a good round of chase with my dog always brings everything down to earth again!

Sleepless on LI wrote:If the bottom line is that we're at greater risk as OSA sufferers for strokes, etc., there isn't a damn thing we can do to change it.

That is exactly what this poorly written study would lead you to think! The fact that I, an individual who has OSA, am at a 2, 3, or 4X greater risk for a stroke isn't the issue. I don't debate that.

The issue is, this so-called scientific study actually published their "findings" that cpap therapy didn't decrease this risk, and they did so WITHOUT EVEN KNOWING if cpap therapy was continued by any of the participants at any level throughout the course of the study. That is absolutely unconscionable!!

I realize these researchers acknowledged, "The present study was not designed or powered to address adherence with treatment or the effect of treatment on outcomes." That being said, they foolishly continue with their conclusion, "Nonetheless, our study demonstrated an increased risk of stroke or death from any cause among patients with the obstructive sleep apnea syndrome despite the administration of various therapies."

Makes one think cpap therapy doesn't work, doesn't it? They really did a tremendous disservice to all cpap users everywhere. How many will quit therapy as a result of reading this study without realizing absolutely not one second of cpap use was verified?

If you read on, you find out that, "... reduced compliance with continuous positive airway pressure and limited efficacy of other treatments may have played a role in the failure of therapy to reduce the risk to baseline levels.

They don't even know if any of the participants used cpap therapy during the 3.4 years of the study!!!!!!!!!!!

They should print a retraction. Maybe scientific studies don't do retractions. Okay, then they should print an addendum.... yeah, that's it, an addendum. They could save face and look all official and scientific-like when they point out they never checked cpap compliance over the 3.4 years of the study, so they really have no idea if cpap therapy reduces the risk of stroke. Then they could say how terribly sorry they are to have written such a misleading study.

Yeah, like that's going to happen...

Here is a link to the full pdf of the article:

Link to New England Journal of Medicine paper on risk factors with OSA

and an editorial on the issue:

Link to New England Journal of Medicine editorial on risk factors with OSA

Thanks to Geocom.

Here's another link that might be interesting, to an article in the Journal of Insurance Medicine regarding risks associated with sleep apnea. Short answer is that the author, a board cretified MD, sees treated apnea as posing no additional risk for purposes of insurance. Many of the problems associated with apnea and high risk actually may be comorbid conditions - hypertension, diabetes, etc., that go along with the apnea. I think that will be a problem with a lot of the studies, controlling for those variables and also ensuring accuracy of data regarding compliance, daytime somnolence levels, etc.

http://apt.allenpress.com/aptonline/?re ... &page=0036

If the bottom line is that we're at greater risk as OSA sufferers for strokes, etc., there isn't a damn thing we can do to change it.

The "bottom line" arrived at by that study was flawed, Lori...a flawed study that came up with a flawed bottom line. never sleeps explained clearly how flawed it was regarding what kind of "treatments" were looked at - weight reduction, upper airway surgery, and CPAP for "at least 4 hours, at least 5 days a week."

The researchers were the ones who oversimplified!!

It would be far more interesting to see a longterm study comparing the bottom line outcomes for people who actually use their CPAP every sleeping moment, including for naps...comparing those people with CPAP users who barely meet the 4 hours a night "compliance" criterion.

Do you really want to know something like that when there isn't a thing you can do to stop it?

But there is! There is a thing most OSA sufferers can do to "stop it"...to stop themselves from arriving at what that particular study held out as was the pessimistic bottom line. A flawed bottom line!

never sleeps pointed out what was wrong with the way the study was conducted and the conclusion that was reached. Flawed study, flawed bottom line. What they were accepting and describing as "cpap treatment" is very different from what REAL cpap treatment can do. REAL treatment. All night long! Not just sporadic 4 hour stints and taking weekends off!!!

CPAP works. But people have to actually put that mask on, turn the machine on, and keep it on -- night after night after night -- no exceptions.

As Janelle says (you knew this was coming, right? LOL) "That's your life hanging on the bedpost -- use it!"

Not you, Lori, since apparently you never should have been put on cpap at all -- you didn't need that kind of treatment. But for those who do have OSA, it is most important to understand how these researchers went way off course. What those researchers call "treatment" is not at all what I'd call treatment for OSA....not even what they regard as "cpap treatment."

But I'm not a doctor; not a researcher. Well, I am when it comes to ME...lol. I'm going to use cpap 100% of the time when I sleep -- not just a few hours each night.

I'm not saying go run out into an expressway with cars doing 80 mph and not expect to die. Tempting fate is not a great suggestion. But I don't see how this information can do anything but scare us. I truly believe that sometimes ignorance is bliss.

I'd be very sorry if anyone really believes the information from that study came up with a valid conclusion. I say it again -- never sleeps absolutely nailed the flaws in that study. Taking such a poor study seriously, thinking "what's the use?" and giving up on CPAP treatment would be like drowsy driving on the expressway you described, Lori. Not a good thing to do.

I hope cpap users who frequent this message board will read, re-read, and re-re-read the points never sleeps raised about those researchers' notions of "treatment" and whether the subjects were really getting true treatment for OSA.

I hear what you're both saying, Laura and Neversleeps. Shame on them for making people worry when they haven't accurately reported on the outcomes since they are admitting to not following up themselves on compliance and other issues or for doing a thorough job. I guess my point is that I feel that you are meant to live a certain journey and I shouldn't dwell on these things. If it's true, so be it. If it's not true, shame on them. But I don't think this will stop anyone from using their CPAP machines. If they are benefitting in their daily routines by increased energy and resolution of health problems, hearing this shouldn't make you stop. It's just one tiny aspect in the grand scheme of OSA and CPAP therapy.

If God meant for you to die of stroke, you will, regardless of what this study or that study says you have an increased or decreased chance of doing. If I had a dollar for every time I've heard that someone had a massive heart attack or a stroke after being at the doctor's office the week before and being given a clean bill of health, I'd be a rich woman. It doesn't matter!!! You can stay on CPAP and live to be 100 or you can die tomorrow of a stroke. Will we be able to say that OSA was the cause? I don't believe so, unless something amazingly coincidental happens and you're being monitored during a PSG or on your home software and it happens to record a five-minute episode that kills you or something along those lines. And I also think life goes by way too fast to bog your mind down with stress that doesn't have to be there.

Although many will disagree with me, I will close my eyes to articles like this. Yes, I will look for positive articles that tell me what is good for me and how to truly make a change in my life by perhaps cutting down on or completely stopping doing certain things that will make a difference. But all the "if"s and "maybe"s I don't care about. I just want to enjoy whatever time I have been blessed with to be on this earth without worrying about my increased chance of this or that. It is different from something that tells you that what you are doing needs to be stopped because it will kill or harm you. This is irrelevent. Who needs this??? I get enough gray hairs without worrying about anything that I can't change, if this is truly valid, and have enough REAL problems to worry about without something of this nature, thank you very much.

A previous poster actually touched on something I've worried over since my first sleep study earlier this year.... being labelled as having OSA for the rest of your life, and potentially being denied or adversely affected in terms of insurance (life, medical, you name it) because of it.

Am I just worrying too much?!?

I agreed to a 2nd study and I went the distance to follow through on starting my CPAP precisely because I did not want to put my health in danger.... I know it's serious business, and I took my doctor's advice and bit the bullet and I'm trying my darndest.

In my case, I'm pretty sure I just need to lose weight. Lots and lots of weight. Prior to having gained all of this weight, I did not snore *at all* and it was a heck of a lot easier to get up in the morning. If CPAP will help me feel better and more motivated to lose weight, then I'll stick with it.

When (I dare not say if) I lose all of this weight, if I'm feeling better and want to get off the CPAP... how do you lose that OSA label??? Are you forced to pay a $2000 exit fee in the form of another sleep study??? We all know what an expensive proposition that is. Or do you just need a note from your doctor that says s/he is pretty sure you're okay? Or a pulse oximeter test like Lori did??

Sorry to be such a bummer tonight...welcome to my world.

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Sleeper,

You're not being a "bummer," but have a very valid point. I would think that since most people don't change their health insurance plans too often in a lifetime, they will know when they stop having to pay for masks, machines and accessories that you no longer need them (or maybe will think you've stopped treating-hmm). I think if you REALLY want to get off their "list" if you think you are suffering as a result of it and really, truly feel you no longer have OSA, then go for a follow-up PSG after you lose all that weight and prove it.

In my case, I think after I did the home oximetry test, that can already help to prove I don't desaturate anymore during sleep. But if they want to pay for a new PSG, I'm ready, willing and very much looking forward to it. I laughed at your saying $2k to get you out of the category as an exit fee when the cost of a PSG is sometimes more than that. Mine was like $3,500, or at least that's what they billed my insurance company. I don't think they got what they asked for, though. But I think your answer would be a final PSG with no evidence of having OSA anymore.

Best of luck losing that weight. You certainly have incentive now to do it if it means getting off the therapy. Keep us all posted.

[quote="walleyek"]I'm 41 and my wife and I went to upgrade my life insurance, but the company found out I've recently gone on CPAP and denied my upgrade as well as increased my current premium. My agent said that sleep apnea, whether treated or not, adversely rates a policy in the same vein as a 2-pack/day cigarette smoker. I'd like to see more positive studies done about CPAP success.

I agree, you are not a bummer Sleeper. If WebMD says 1 in 5 men have OSA, then why should we be penalized for taking the teatment?

Also, God bless you and I hope you lose the weight. I bet most of us should lose weight and not just 10 pounds.

Also, the Central SA study was not as conclusive as you might think. There are holes in it.

Lori -- You are the LAST person I would expect to take the position that you have taken. Just last week you were anguishing over whether or not to discontinue your CPAP therapy. Does this article not give you a serious hint about the risk of "guessing" wrong? Or at least what the impact might be on someone with a more serious apnea problem than yours who is anguishing with the same ambivalence? With all of the flaws pointed out in this thread, the study still seems to me to say, at a minimum, that if you have apnea and do nothing about it, it is very much akin to driving recklessly, to use your metaphor.


Rested Gal -- a somewhat unrelated point, but I have noticed in this thread and several of your previous postings that you are more than just a tad cynical about a surgery solution. I had my UPPP twelve years ago. My Apnea readings were at that point in the upper seventies. (yup, 70's!) My surgeon told me that the BEST results I could expect would be about a 50% reduction, so I would still require lifelong cpap therapy. He was right on target. Post surgery sleep study was down from 70's to low 30's. Now, with an average pressure of 11 (apap range 7-14) I have an AHI that seldom exceeds 1.0. The surgery was a major pain in the neck, as it were, but in my instance, well worth it, I beleive, despite the fact that I will never know if I would have had the same results using cpap without the surgery.