OSA Progress

Progress is being made in efforts to rope in galloping obstructive sleep apnea (OSA) statistics, and the healthcare dollars they demand.

“Last year was a big year for sleep apnea research, as it revealed more helpful discoveries about the disease and its relationship with costly chronic conditions and related events that can occur,” said Adam Benjafield, PhD, ResMed vice president of medical affairs. “2015 promises to be just as productive with new advances, technologies and discoveries to help us curb the widespread impact sleep apnea has on health, quality of life, and our healthcare system overall.”

That said, OSA still is not without continual challenges. “”Adherence to PAP therapy is one of the most challenging aspects of sleep medicine,” Benjafield told ADVANCE. “Many sleep apnea patients stop using their PAP devices within one year, yet therapy is effective only when used regularly. On top of that, home medical equipment providers suffer when patients are not compliant, as they must meet strict regulations in order to receive reimbursements for the devices they provide.

“Thankfully, healthcare informatics solutions are increasingly making their way into the treatment and management of sleep apnea, to help providers keep better track of patients and help them overcome hurdles to achieving regular therapy,” he noted. “These types of solutions will go a long way to help HMEs, who are increasingly asked to do more with less, as they seek to boost efficiencies and improve overall effectiveness of treatment.”

SEE ALSO: Capnography and Sleep Apnea

Progress at a Glance
Pinpointing the top five research discoveries related to sleep apnea in the past year, ResMed issued a statement saying, “Together, these findings reinforce not only the impact that untreated sleep apnea can have on overall health and wellness, but also the role that consistent treatment with available therapies can play in improving sleep apnea and related conditions.” Here are their choices for elite sleep research and findings:

1. Sleep apnea factors are associated with up to 50% increased risk of certain cardiovascular outcomes. OSA factors, such as the number of awakenings, mean heart rate, total sleep time, sleep time spent with oxygen saturation <90%, or presence of excessive daytime sleepiness, were associated with a five to 50% percent increased risk of experiencing cardiovascular outcomes. [Obstructive sleep apnea and risk of cardiovascular events and all-cause mortality: A decade-long historical cohort study. (Kendzerska et al., 2014 PLoS Medicine)]

2. Continuous Positive Airway Pressure (CPAP) therapy leads to better-controlled diabetes. In this case-controlled study of OSA patients with type 2 diabetes, CPAP was found to be a cost-effective treatment leading to significantly lower blood pressure and better-controlled diabetes, affording a cost-effective use of National Health Services resources. Widely accepted as the gold standard, CPAP therapy involves wearing a mask or nasal pillows system connected to a small portable airflow generator that delivers air at positive pressure, creating an air splint to keep the airway open. [Clinical outcomes and cost-effectiveness of CPAP to manage OSA in patients with Type 2 Diabetes in the UK. (Guest et al., 2014 Diabetes Care)]

3. OSA recurs after four nights of CPAP withdrawal in majority of patients. In more than 70% of patients studied, OSA recurred after four nights of withdrawal from CPAP therapy. Additionally, patients with higher risk factors for OSA prior to starting therapy had worse OSA symptoms upon CPAP withdrawal. These results demonstrate the importance of consistent therapy usage. [Is continuous positive airway pressure necessarily an everyday therapy in patients with obstructive sleep apnea? (Rossi et al., 2014 Eur Respir J)]

4. CPAP reduces sleep apnea-related risk of car accidents. Sleepiness at the wheel is a major cause of motor vehicle accidents. A Swedish traffic study that addressed a large, well-characterized patient cohort referred for OSA investigation found that the incidence of motor vehicle accidents was reduced by 70% among OSA patients with high CPAP compliance, whereas it increased 54% among non-compliant patients. During the corresponding time window from 2007 to 2012, there was an observed decrease of accidents by 15.9% in the Swedish Traffic Accident Registry. The study results demonstrate CPAP’s success in treating OSA patients, while the motor vehicle accident risk in these OSA patients suggests a need for accurate tools to identify individuals at risk. [Sleep-Apnea Related Risk of Motor Vehicle Accidents is Reduced by Continuous Positive Airway Pressure: Swedish Traffic Accident Registry Data. (Karimi et al., 2014 Sleep)]

“Pinpointing the top five research discoveries related to sleep apnea in the past year.”

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5. Overwhelming majority of patients with complex sleep apnea experience positive results with adaptive servo-ventilation (ASV). While two-thirds of participants in this study experienced success with CPAP, approximately 90% experienced success with ASV at 90 days of therapy. ASV is a method of ventilator support aimed to treat central sleep apnea, and is currently being investigated as a treatment option for sleep apnea patients with heart failure and other cardiovascular conditions. [The complex sleep apnea resolution study: a prospective randomized controlled trial of continuous positive airway pressure versus adaptive servo ventilation therapy. (Morgenthaler et al., 2014 Sleep)]

Toward Better Outcomes
Together, the research findings show that consistent sleep apnea treatment with CPAP and ASV therapies not only significantly improves apnea symptoms, but can also positively impact several comorbid disease types and everyday functionality.

“I think the future will bring a better understanding of sleep apnea’s relationship to other chronic illnesses,” said Benjafield. “The condition is already associated to diabetes, cancer, stroke, obesity, depression, cardiovascular diseases like heart failure and more, and new insights will help us continue to innovate and advance the way we approach treatment. There are a number of ongoing trials investigating the impact sleep apnea treatment has on other serious conditions, and I’m looking forward to learning as much as we can to ensure our approaches are holistic and well informed.”

Valerie Neff Newitt is managing editor at ADVANCE. Contact [email protected].

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