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No Proof That Cpap Works!!!
A study in the April 1 issue of the journal SLEEP suggests that the risk
of death is more than two times higher in older adults who have sleep apnea and
report struggling with excessive daytime sleepiness.
Results of adjusted
proportional hazards modeling show that older adults with moderate to severe
sleep apnea who reported struggling with excessive daytime sleepiness at
baseline were more than twice as likely to die (hazard ratio = 2.28) as subjects
who had neither problem. The risk of death was insignificant in older adults
with only excessive daytime sleepiness (HR = 1.11) or sleep apnea (HR = 0.74).
Participants had a mean age of 78 years at baseline, and about 55 percent (n =
160) died during an average follow-up period of 14 years.
"Excessive
daytime sleepiness, when associated with sleep apnea, can significantly increase
the risk of death in older adults," said principal investigator and lead author
Dr. Nalaka S. Gooneratne, assistant professor of medicine in the University of
Pennsylvania Health System in Philadelphia, Pa. "We did not find that being
sleepy in and of itself was a risk. Instead, the risk of increased mortality
only seemed to occur when sleep apnea was also present."
Gooneratne
added that both daytime sleepiness and sleep apnea are common problems, with
sleep apnea affecting up to 20 percent of older adults.
According to the
American Academy of Sleep Medicine, the most common form of sleep apnea is obstructive sleep apnea, which occurs when soft
tissue in the back of the throat collapses and blocks the upper airway during
sleep. Older adults also are at risk for central sleep apnea, which involves a
repetitive absence of breathing effort during sleep caused by a dysfunction in
the central nervous system or the heart. Only four percent of participants had
central sleep apnea, and there was no meaningful change in the results when they
were excluded from the analysis.
The study involved 289 adults with
neither dementia nor depression who were recruited from the community.
Seventy-four percent were female. About half (n = 146) had significant levels of
excessive daytime sleepiness at baseline, reporting that they felt sleepy or
struggled to stay awake during the daytime at least three to four times a week.
Sleep apnea was measured objectively by one night of polysomnography in a sleep
lab. For analysis, participants were included in the sleep apnea group only if
they had an apnea-hypopnea index of 20 or more breathing pauses per hour of
sleep, which represents a moderate to severe level of sleep apnea.
Participants were recruited between 1993 and 1998. Survival status was
determined by searching the social security death index, with follow-up ending
Sept. 1, 2009.
According to the authors, the mechanism by which sleep
apnea and excessive daytime sleepiness increase the risk of death is unclear.
They suspect that inflammation may be involved, which could increase the risk of
other medical problems such as hypertension. It also remains to be seen if
treatment reduces the risk of death.
"Future research is needed to
assess whether treating the sleep apnea can reduce mortality," said Gooneratne.
The treatment of choice for OSA is CPAP therapy, which provides a steady
stream of air through a mask that is worn during sleep. This airflow keeps the
airway open to prevent pauses in breathing and restore normal oxygen levels.
The study was supported by the National Institutes of Health through the
National Institute on Aging and the National Center for Research Resources.
Source:
Emilee McStay
American Academy of Sleep Medicine
of death is more than two times higher in older adults who have sleep apnea and
report struggling with excessive daytime sleepiness.
Results of adjusted
proportional hazards modeling show that older adults with moderate to severe
sleep apnea who reported struggling with excessive daytime sleepiness at
baseline were more than twice as likely to die (hazard ratio = 2.28) as subjects
who had neither problem. The risk of death was insignificant in older adults
with only excessive daytime sleepiness (HR = 1.11) or sleep apnea (HR = 0.74).
Participants had a mean age of 78 years at baseline, and about 55 percent (n =
160) died during an average follow-up period of 14 years.
"Excessive
daytime sleepiness, when associated with sleep apnea, can significantly increase
the risk of death in older adults," said principal investigator and lead author
Dr. Nalaka S. Gooneratne, assistant professor of medicine in the University of
Pennsylvania Health System in Philadelphia, Pa. "We did not find that being
sleepy in and of itself was a risk. Instead, the risk of increased mortality
only seemed to occur when sleep apnea was also present."
Gooneratne
added that both daytime sleepiness and sleep apnea are common problems, with
sleep apnea affecting up to 20 percent of older adults.
According to the
American Academy of Sleep Medicine, the most common form of sleep apnea is obstructive sleep apnea, which occurs when soft
tissue in the back of the throat collapses and blocks the upper airway during
sleep. Older adults also are at risk for central sleep apnea, which involves a
repetitive absence of breathing effort during sleep caused by a dysfunction in
the central nervous system or the heart. Only four percent of participants had
central sleep apnea, and there was no meaningful change in the results when they
were excluded from the analysis.
The study involved 289 adults with
neither dementia nor depression who were recruited from the community.
Seventy-four percent were female. About half (n = 146) had significant levels of
excessive daytime sleepiness at baseline, reporting that they felt sleepy or
struggled to stay awake during the daytime at least three to four times a week.
Sleep apnea was measured objectively by one night of polysomnography in a sleep
lab. For analysis, participants were included in the sleep apnea group only if
they had an apnea-hypopnea index of 20 or more breathing pauses per hour of
sleep, which represents a moderate to severe level of sleep apnea.
Participants were recruited between 1993 and 1998. Survival status was
determined by searching the social security death index, with follow-up ending
Sept. 1, 2009.
According to the authors, the mechanism by which sleep
apnea and excessive daytime sleepiness increase the risk of death is unclear.
They suspect that inflammation may be involved, which could increase the risk of
other medical problems such as hypertension. It also remains to be seen if
treatment reduces the risk of death.
"Future research is needed to
assess whether treating the sleep apnea can reduce mortality," said Gooneratne.
The treatment of choice for OSA is CPAP therapy, which provides a steady
stream of air through a mask that is worn during sleep. This airflow keeps the
airway open to prevent pauses in breathing and restore normal oxygen levels.
The study was supported by the National Institutes of Health through the
National Institute on Aging and the National Center for Research Resources.
Source:
Emilee McStay
American Academy of Sleep Medicine
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