Is SDB progressive?

[krousseau]

Any one who knows anything abut OSA being progressive. I'm talking about "regular" OSA--not OSA that is secondary to another condition known to be progressive.

[Guest]

-not OSA that is secondary to another condition known to be progressive.

I'm having trouble understanding what might cause OSA to become progressive? A secondary example please. And could you define what you mean by progressive.

Would putting on weight cause OSA to become progressive?

[bdp522]

I think the question is;
Will regular old run of the mill OSA get worse over time(causing higher AHI), given that there are no other changes made(no weight gain, no illnesses, no change in physical activity, no dietary changes, etc)?

Brenda

[krousseau]

YES Brenda-that is exactly the question. No weight gain (in fact I've lost), the RLS is minimal with medication (and did a couple months without that med to see if it made a difference). As to possible reasons for it to get worse....it could be age related....loss of muscle tone ....the "firm years" are past. I check my data for leaks etc-that isn't it.

[bdp522]

Age related loss of muscle tone sounds very likely to me. Of course I'm just another cpapper, not a medical professional. I have spent ALOT of time in nursing homes(working & visiting) and have seen age related loss of muscle tone result in many problems including breathing issues.

Brenda

[-SWS]

Hey krousseau! Good to see you!

My impression is that standard obstructive apnea is not considered an inherently progressive disease. Changes can occur for a variety of reasons, some of which have already been mentioned in this thread. Additionally plenty of night-to-night variability can occur for a variety of reasons as well.

Because obstructive apnea is not an inherently progressive disease, any vast and consistent progression should probably be investigated. Transitional cardiac disease, asthma, acid reflux, and a veritable host of other possible comorbidities that may be new to you can adversely affect AHI.

[Guest]

No Change in mask, sleeping position, meds, or hose length? Check machine for calibration pressure? How much of a change are we talking?

The body does change thru the years.

[Georgio]

II. What are the effects of obstructive sleep apnea?

Sleep apnea is a progressive disease. Mild snoring converts gradually to sleep apnea as more negative pressures are created because of weight gain, aging, etc. Initially this may be only a few apneas per night. As the number of apneic events increases, both physical and mental symptoms develop. These are usually not noted until there are at least 50 or more events per night.

These are several symptoms which indicate the possible presence of apnea:

Weight gain
Fitful sleep
Tired appearance
Loud snoring
Mumbling in sleep
Drooling on the pillow
Frequent urination at night
These cognitive (mental) dysfunctions may be present:

Poor concentration
Inappropriate asleep
Poor memory
Increased irritability
Chronic fatigue
Decreased libido
Some depression
Claustrophobia
Rapid sleep onset
Avoidance of social events
Awakening with a headache
Sweating in sleep
Long-term effects of sleep apnea include:

Increased risk of cardiovascular disease, heart attack, stroke, angina pectoris (chest pains) and hypertension
Impaired performance at work and home
Symptoms may vary among patients, but most will have several of the above complaints. These problems are generally reversible with treatment. *1

*1 ©Sleep Consultants, Inc. 2007

[-SWS]

II. What are the effects of obstructive sleep apnea?

Sleep apnea is a progressive disease. Mild snoring converts gradually to sleep apnea as more negative pressures are created because of weight gain, aging, etc.<snip>
*1 ©Sleep Consultants, Inc. 2007

Thanks for posting that, Georgio. Indeed, when I Google for "sleep apnea is a progressive disease" I get 214 hits, almost all of which are marketing style literature from clinics. I'm admittedly surprised to hear it categorized as a progressive disease. And I will say that much of that literature describes the transition of the disease, going from snoring with little or no pathology to full-blown apnea entailing pathology. Those marketing style write ups also then go on to cite factors that can exacerbate apnea, as if that constitutes a progressive disease. But you know what? An inherently progressive disease, generally speaking, will progress more often than not throughout the life of that disease. And that doesn't seem to be what the vast majority of people on apnea message boards report after getting beyond disease transition (from a state of no pathology).

Head over to Google scholar, where the sleep clinic marketing literature is replaced by medical white papers and I see only one white paper that contends "mild obstructive sleep apnea is a progressive disease" (thus transitional cases?). You do see more white papers there contending that an epidemiological relationship between age and apnea severity is unknown. So I guess there's some gray area for interpretation about what constitutes a truly progressive disease. All diseases that entail a transitional period during pathogenesis arguably "progress". However, progressive diseases are inherently and almost universally progressive throughout the disease's life cycle, and standard obstructive apnea does not seem to fit that pattern for most of us--at least not that we're aware of yet. However, I am under the impression that the jury is still out where the empirical branch of medicine known as epidemiology is concerned.

[jnk]

Progressive? Well, when it comes to OSA, few of us were born with the problem, so I guess it has to start sometime somewhere, and then it has to get worse to get noticed. So technically maybe. And I would think that untreated OSA could continue to get worse from the snoring that could tend to elongate and break down tissue, if that is indeed what happens. But it also seems to me that successful PAP therapy should stop all of that in its tracks. Thus the importance of our making sure that our treatment is completely successful on an individual basis, even when it comes to snoring.

Only a newbie opinion, that.

[krousseau]

Aging itself is, in a manner of speaking, progressive.

The "natural" progression of snoring to OSA is not merely mechanical, ie elogation of the uvula, it is due to neurological damage from the vibration of the tissues-similar to the damage in the hands of jackhammer operators.

We are not looking at big changes-or sudden changes. Might not notice it if I didn't have encore. Just that where I almost always had an AHI under 1, now it is rarely under 1. I was reevaluated and started on BiPAP with higher pressures around my second year of treatment-now going onto year three. I'll bump my pressures up (and let the clinic know) if the AHI keeps going up.

[Georgio]

It sounds like most here agree that CPAP treatment effectively "stops" the progression if in fact it progresses. I know I have gotten progressively worse for a number of years to the point where I had to do something....!

[jnk]

http://www.pubmedcentral.nih.gov/picren ... obtype=pdf

1997. But interesting.

[Georgio]

That paper was very interesting. I wonder if the medical world has developed a more concise conclusion regarding progressiveness. I have read many things that state OSA is "progressive".

On the other hand, my most severe symptoms came on relatively quickly, over the course of only one and one half years. Even though I snored like a banshee forever. Could the onset be rapid? Maybe you could reach a certain "maturity", your airway collapses and you wake up with your heart pounding out of your chest. From my experience it could evolve expedientially.

Frankly, a year and a half ago, I could go to to work 8-9 hours day, swim 3/4 mile and go to a club till 1:00 am and be at work the next morning, including 60 miles of motorcycle driving. I thought I was doing well for 56.

Then, the twice weekly lap swimming stopped. My muscles just refused to do it. Next, the motorcycle riding to work stopped. I just didn't feel alert enough or had enough energy to do it.

Next, I found myself going thru my day with my mouth hanging open, double circles under my eyes, repeating to myself over and over, "I'm sotired! "

After 3 weeks of cpap (and help here) I feel like my body is repairing itself and I even have some energy.
Suddenly, I'm able to ride a bicycle several miles, and I'm not repeating how tired I am all day.

Are there any more experienced cpap users that can tell us if their CPAP treatment needs to be "adjusted" as years go on?

Thanks,

Georgio

[jnk]

. . . neurological damage from the vibration of the tissues-similar to the damage in the hands of jackhammer operators. . . .

Well put. Recently "proved" by Egyptian dudes who got paid to stay up nights straining their eyeballs counting little bitty nerves and comparing them to dead people:

1: J Laryngol Otol. 2008 Jun 13:1-5. [Epub ahead of print]Links
Electron microscopy study of peripheral nerves in the uvulae of snorers and obstructive sleep apnoea patients.Bassiouny A, Nasr S, Mashaly M, Ayad E, Qotb M, Atef A.
Department of Otolaryngology, Cairo University, Egypt.

Hypothesis:The pathophysiology of snoring and obstructive sleep apnoea is still unclear. Two theories are proposed. The first is the obstructive theory, which postulates palatopharyngeal muscle hypertrophy leading to airway narrowing; there is no neural role. The second is the neurogenic theory, which postulates neural degeneration due to vibratory stretch trauma, leading to muscle atrophy and collapse. As identification of nerve fibres in the uvula and palate is difficult and time-consuming, all previous studies aiming to differentiate between these two theories have been based on indirect observation of the muscles, rather than direct study of the nerves.Methods:We conducted a prospective study to directly observe and study nerve fibres in uvular specimens from 10 cases of obstructive sleep apnoea, compared with specimens from 10 cases of simple snoring, using transmission electron microscopy. Five autopsy cases served as controls.Results:Obstructive sleep apnoea was associated with definite degenerative changes in myelinated and unmyelinated nerve endings. These degenerative changes were present to a lesser degree and in a smaller proportion of cases of simple snoring.Conclusion:The events postulated by the neurogenic theory of obstructive sleep apnoea appear to play an important role in the pathophysiology of snoring and obstructive sleep apnoea.

PMID: 18549514 [PubMed - as supplied by publisher]

http://www.ncbi.nlm.nih.gov/pubmed/18549514