Are We Enetring a new Era in OSA Therapy?

RobertS975 wrote:CPAP has continued to evolve and improve for decades. It would be a big mistake for anyone to assume that this new technology, still in its infancy, will not do the same... evolve and improve.

Everything in our society “piggybacks” on the stuff that is already in place. That’s why when you need to stay home from work because of sickness a doctor has to sign a form for you (a self-serving one entirely dependent on the patient’s representations). This is in everything. The resulting problem is that doctors start believing that they are right. It empowers them. We are left with no tonsils in the 50’s, 60’s and 70’s; no appendixes in the 50’s 60’s and 70’s, lots of “puffers” in the 80’s, lots of missing gallbladders, carpel tunnel, statins (when not even a one study shows any relationship with cholesterol), high blood pressure medication that doesn’t extend life expectancy….the list is endless. The civil engineers extended life by giving us clean water.

Pesser wrote:

RobertS975 wrote:CPAP has continued to evolve and improve for decades. It would be a big mistake for anyone to assume that this new technology, still in its infancy, will not do the same... evolve and improve.

Everything in our society “piggybacks” on the stuff that is already in place. That’s why when you need to stay home from work because of sickness a doctor has to sign a form for you (a self-serving one entirely dependent on the patient’s representations). This is in everything. The resulting problem is that doctors start believing that they are right. It empowers them. We are left with no tonsils in the 50’s, 60’s and 70’s; no appendixes in the 50’s 60’s and 70’s, lots of “puffers” in the 80’s, lots of missing gallbladders, carpel tunnel, statins (when not even a one study shows any relationship with cholesterol), high blood pressure medication that doesn’t extend life expectancy….the list is endless. The civil engineers extended life by giving us clean water.

Could not have said it better myself!

Don't forget terrible orthodontic treatment, especially what they call "Four on the Floor," or extraction of 4 bicuspids to slap braces and/or headgear on children, without any regard for their airway, and how that "treatment" greatly affects their airway in years to come. Yes, they are STILL doing it (about 90% of American dentists, and the stats are even worse in Europe).

3-Part Show from 60 Minutes (Australia):
Dr. Derek Mahony

PART 1

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


PART 2

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

PART 3

https://www.youtube.com/watch?v=oKMu38k8 ... FE&index=3

purple wrote:Truth is, I should have taken band beginning in elementary school and blown something that required circular breathing.

Any of you going to encourage you grand children (and such) to join band?

Was in band. Played trombone.

To the people who say forget the implant and forever stay with CPAP....

How great would it be if I, at the age of 30, wouldn't need to worry about a machine and mask for the rest of my life.

How amazing would it be for me to be able to take my trip to Europe and not worry about lugging a machine with me and finding appropriate outlets.

I would LOVE to take my son camping when he's old enough in a couple years and not worry about bringing a gigantic car battery with me.

I sure wish that my wife and I could snuggle in bed and fall asleep, instead of me always having to remember to roll over and hook up my mask.

Yup, I can't take a nap out on the porch, or in the sunroom during a rainstorm, because well, my cpap is upstairs in my bedroom.

I often wonder when my power will go out for the first time since starting CPAP. I am scared that I won't wake up until my 02 has gotten really low. and then, what if the power is out all night?


You see that picture now? Some of us who are active and mobile would love the option of a device that could treat us. I would not consider one until it ran through multiple clinical trials and had an extremely high success rate, but what an amazing option that could be.

We'll see what the future brings, I am keeping an open mind.

What was it President Reagan said, echoing the old Russian proverb? Trust but verify. I'd wait awhile before I would have that procedure done, however I'm glad they are working on other solutions addressing OSA.

icipher wrote:To the people who say forget the implant and forever stay with CPAP....

I would say: Forget nothing. In fact, feel free to be entertained by salesmen's projections for their future products whenever fantasizing about what the future may hold. It's fun! I hope one day to buy some magic beans that will make my spare tire fall off. Cool! And wouldn't it be amazing if all the crap sold on TV really worked? YES!!

But in the meantime, always use the scientifically-proven-gold-standard treatment of the moment when you can--unless, of course, your unique circumstance would make some other approach more successful for you than the gold-standard approach would be for your unique situation.

jnk wrote:...my spare tire...

Which reminds me, I was only carrying a tube and patch kit on Sunday (didn't need it, tho), but I was looking for you as I rode by on Sunday. Missed you!

Sludge wrote:. . . rode by on Sunday. . .

We weren't home. But thanks for blocking our car into the lot. The 2 train only got us as far as Franklin Ave., and we had to take a shuttle bus the rest of the way.

And BTW, would it kill you guys to put some fresh asphalt on them roads?

I mean, it felt like Rat Patrol half the time...

Potholes are how we enforce the speed limit.

If we paved the roads, we'd just have to install speed bumps every few feet.

From: http://www.atsjournals.org/doi/abs/10.1 ... 303-0448OC#

Measurements and Main Results: Pathophysiologic traits varied substantially among participants. A total of 36% of patients with OSA had minimal genioglossus muscle responsiveness during sleep, 37% had a low arousal threshold, and 36% had high loop gain. A total of 28% had multiple nonanatomic features. Although overall the upper airway was more collapsible in patients with OSA (Pcrit, 0.3 [−1.5 to 1.9] vs. −6.2 [−12.4 to −3.6] cm H2O; P <0.01), 19% had a relatively noncollapsible upper airway similar to many of the control subjects (Pcrit, −2 to −5 cm H2O). In these patients, loop gain was almost twice as high as patients with a Pcrit greater than −2 cm H2O (−5.9 [−8.8 to −4.5] vs. −3.2 [−4.8 to −2.4] dimensionless; P = 0.01). A three-point scale for weighting the relative contribution of the traits is proposed. It suggests that nonanatomic features play an important role in 56% of patients with OSA.

Conclusions: This study confirms that OSA is a heterogeneous disorder. Although Pcrit-anatomy is an important determinant, abnormalities in nonanatomic traits are also present in most patients with OSA.


CPAP can treat some. Hypoglossal nerve stimulation (HGNS) can treat some. If you catch it early enough and are obese there is a 57% chance that diet and exercise aimed at weight loss can cure your sleep apnea for at least a year[1]. That may be more than can even use CPAP for more than four hours a night at the one year mark!

I think we are entering a new era where we know enough about sleep apnea to effectively target a cure. May it come soon!!!!!!!

[1] Tuomilehto H, Uusitupa M. Lifestyle changes aiming at weight loss should always be included in treatment of obese patients with obstructive sleep apnea. SLEEP 2014;37(5):1021

Todzo wrote: ?

"Another sleepness night, a sun that won't fall."--Neil.
https://www.youtube.com/watch?v=Jv-knusIj0w

Reducing severity is not the same thing as curing, despite the misunderstandings floating around out there that are based on poorly executed "studies." I agree, for example, that the few people with sudden recent weight gain can theoretically sometimes get themselves on the other side of the OSA line in the sand (an AHI of 5) if they lose and keep off the recent sudden gain. But I also agree with the careful wording below:

Review: Weight loss improves but fails to cure sleep apnea
AASM -- Thursday, October 3, 2013

Lifestyle and dietary interventions promoting weight loss improve obstructive sleep apnea parameters but are insufficient to normalize them, according to a literature review and meta-analysis in the October issue of the journal SLEEP. The review analyzed 21 studies representing 893 patients with OSA. Overall, few studies demonstrated normalization of AHI with weight loss interventions. Results also suggest that interventions employing physical activity alone were unsuccessful in reducing AHI. A combination of diet and physical activity, however, resulted in significant AHI reductions that could be clinically relevant in some patients by reducing sleep apnea severity.--http://www.aasmnet.org/articles.aspx?id=4226

The recommendation to encourage patients to lose weight was strong but with low-quality evidence....The AASM supports the ACP's guideline recommendation of weight loss for overweight or obese OSA patients, the statement said. "However, it is important to emphasize that weight loss should be combined with another OSA treatment such as CPAP, because of the low success rate of dietary programs and the low cure rate by weight loss alone," the AASM cautions.

The new ACP recommendations for CPAP as first line and oral appliance therapy as a treatment alternative "are in line with the AASM's previously published clinical guideline," the AASM told Medscape Medical News.--http://www.medscape.com/viewarticle/811535#2

Great study JNK. Thanks for providing the link.

jnk wrote:

Todzo wrote: ?

"Another sleepness night, a sun that won't fall."--Neil.
https://www.youtube.com/watch?v=Jv-knusIj0w

Reducing severity is not the same thing as curing, despite the misunderstandings floating around out there that are based on poorly executed "studies." I agree, for example, that the few people with sudden recent weight gain can theoretically sometimes get themselves on the other side of the OSA line in the sand (an AHI of 5) if they lose and keep off the recent sudden gain. But I also agree with the careful wording below:

Review: Weight loss improves but fails to cure sleep apnea
AASM -- Thursday, October 3, 2013

Lifestyle and dietary interventions promoting weight loss improve obstructive sleep apnea parameters but are insufficient to normalize them, according to a literature review and meta-analysis in the October issue of the journal SLEEP. The review analyzed 21 studies representing 893 patients with OSA. Overall, few studies demonstrated normalization of AHI with weight loss interventions. Results also suggest that interventions employing physical activity alone were unsuccessful in reducing AHI. A combination of diet and physical activity, however, resulted in significant AHI reductions that could be clinically relevant in some patients by reducing sleep apnea severity.--http://www.aasmnet.org/articles.aspx?id=4226

From a recent editorial in SLEEP[1]:

Recent data suggest that patients get OSA for variable reasons. With some having primarily an anatomical problem, whereas others may have dysfunction in pharyngeal dilator muscles and still others may have instability in ventilatory control as a major predisposing factor [12,13]. A concept of personalized medicine is thus emerging, such that therapies targeting underlying mechanism may be a method of treating apnea in carefully diagnosed patients.

[1] Orr J, Javaheri S, Malhotra A. Comparative effectiveness research in complex sleep apnea. SLEEP 2014;37(5):833-834

[12] Eckert DJ, White DP, Jordan AS, Malhotra A, Wellman A, authors. Defining phenotypic causes of obstructive sleep apnea. Identification of novel therapeutic targets. Am J Respir Crit Care Med. 2013;188:996-1004.

[13] Wellman A, Jordan AS, Malhotra A, et al., authors. Ventilatory Control and airway anatomy in obstructive sleep apnea. Am J Respir Crit Care Med. 2004;1225-32

Todzo wrote:From: http://www.atsjournals.org/doi/abs/10.1 ... 303-0448OC#

Measurements and Main Results: Pathophysiologic traits varied substantially among participants. A total of 36% of patients with OSA had minimal genioglossus muscle responsiveness during sleep, 37% had a low arousal threshold, and 36% had high loop gain. A total of 28% had multiple nonanatomic features. Although overall the upper airway was more collapsible in patients with OSA (Pcrit, 0.3 [−1.5 to 1.9] vs. −6.2 [−12.4 to −3.6] cm H2O; P <0.01), 19% had a relatively noncollapsible upper airway similar to many of the control subjects (Pcrit, −2 to −5 cm H2O). In these patients, loop gain was almost twice as high as patients with a Pcrit greater than −2 cm H2O (−5.9 [−8.8 to −4.5] vs. −3.2 [−4.8 to −2.4] dimensionless; P = 0.01). A three-point scale for weighting the relative contribution of the traits is proposed. It suggests that nonanatomic features play an important role in 56% of patients with OSA.

Conclusions: This study confirms that OSA is a heterogeneous disorder. Although Pcrit-anatomy is an important determinant, abnormalities in nonanatomic traits are also present in most patients with OSA.


CPAP can treat some. Hypoglossal nerve stimulation (HGNS) can treat some. If you catch it early enough and are obese there is a 57% chance that diet and exercise aimed at weight loss can cure your sleep apnea for at least a year[1]. That may be more than can even use CPAP for more than four hours a night at the one year mark!

I think we are entering a new era where we know enough about sleep apnea to effectively target a cure. May it come soon!!!!!!!

[1] Tuomilehto H, Uusitupa M. Lifestyle changes aiming at weight loss should always be included in treatment of obese patients with obstructive sleep apnea. SLEEP 2014;37(5):1021