Treatment of Obstructive Sleep Apnea and Hypopnea—We Are Not There Yet!

摘要: Recently available data from a number of studies provide convincing evidence that obstructive sleep apnea hypopnea (OSAH) is an independent risk factor for the development cardiovascular disease (CVD) and increased mortality.1–3 Even if prevalence OSAH assumed to be 2% 4% in general population, arguably conservative estimate, significant public health concern. Initial consideration these findings would suggest we as Sleep Medicine practitioners should diligent identifying prescribing treatment internists family are elevated lipids hypertension. As much this strategy attractive scientific perspective, there some important gaps our knowledge with respect impact on all segments population well practical barriers preclude implementation. Although recent prospective observational have demonstrated appears CVD mortality,2,3 it not clear uniform across population. Data presented last year by Heart Health Study indicate mortality incident primarily found men less than 70 years age, little effect women older men.4 The absence adverse consistent previous study large clinical cohort.1 Furthermore, longitudinal populations demonstrating been performed cohorts comprised predominantly or entirely men.1,5,6 Thus, can argued CVD, any, women, perhaps remains determined. Perhaps equally vexing issue question who treat. Review several risks persons AHI < 15 may very low absent. For example, frequently cited Marin et al, appeared present only those ≥ 30.5 Moreover, Busselton study, increase all-cause was associated RDI 15.2 Many individuals sleepy feel unrested7 medical attention other reasons. Can justify mild symptoms given lack definitive group? In particular, treated? The treat modalities were plentiful highly effective. Unfortunately, neither case. There 4 commonly employed therapeutic OSAH: weight loss, upper airway surgery, oral appliances, positive pressure (PAP). Excluding surgical procedures diet programs Upper surgery modestly efficacious at best, even effective.8 Oral appliances PAP therapy efficacious, but their effectiveness rates desirable.9,10 Long-term use reported ∼60%.10 This latter observation now reflected Medicare regulations, which require documentation both compliance improvement continued reimbursement therapy. The aforementioned realities challenges field Medicine. One most conditions prevalent unclear whether treated. limited published provided information concerning OSA, yet' unresolved issues remain. Additional research will required community industry effectively epidemic OSA.