Friday, August 27, 2010

Obstructive Sleep Apnea - More than about sleep!!


Sleep apnea has long been considered something that improves the quality of life for patients. However, it's becoming more clearer that OSA obviously has metabolic effects way more important than just helping people sleep and feel better in the morning.

Severity of OSA correlates with diabetes control. According to a study published just last December 2009 at AJRCCM, compared with patients without OSA, the adjusted mean HbA1c was increased by 1.49% in patients with mild OSA, 1.93% in patients with moderate OSA, and 3.69% in patients with severe OSA (P < 0.0001 for linear trend).

Treating heart failure patients with OSA can actually improve CHF. In the first randomized trial involving 24 patients with heart failure (EF < 45%) and moderate to severe OSA, 30 days of CPAP lowered daytime heart rate and systolic BP and increased ejection fraction by 9%. In contrast, there was no change in any of these variables in the 12 patients in the control group.

Lastly treating OSA actually helps with atherosclerosis! A small Brazilian study of 24 patients published in AJRCCM showed that 4 months of CPAP in people with OSA made a significant decrease occurred in carotid intima-media thickness, pulse-wave velocity , C-reactive protein , and catecholamines after 4 months of CPAP.

The impact of OSA on cardiovascular disease and stroke is so profound that the AHA/ACC actually produced a consensus statement about this.

So, treating OSA should be as much of a priority as those pills everybody likes prescribing!!

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