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Steven B. Ronsen updated their profile
Sep 15

American Heart Association Gives OSA Patients the Finger

I have personally approached the marketing/ communications director of the American Heart Association to work together with the NYC AWAKE group to spread OSA awareness, and she essentially told us to pound sand because the connection between OSA and heart disease was not sufficiently proven. Outrageous, huh?

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new study about cardiovascular disease-OSA connection:

September 24, 2010 (Barcelona, Spain) — The latest findings from a Swedish study suggest that obstructive sleep apnea (OSA) might be a stronger risk factor for coronary artery disease (CAD) than commonly recognized factors like obesity, diabetes, smoking, and hypertension, and even more prevalent in the CAD population than has been previously reported.

Here at the European Respiratory Society 2010 Annual Congress, Yuksel Peker, MD, a pulmonologist at Skaraborg Hospital in Skövde, Sweden, presented the latest findings from the ongoing Randomized Intervention with CPAP in Coronary Artery Disease and Sleep Apnoea (RICCADSA) trial.

RICCADSA was initiated in December 2005 to address the impact of continuous positive airway pressure (CPAP) on patients who had undergone revascularization for CAD and who had documented OSA.

The study is ongoing, Dr. Peker acknowledged, but analyses of baseline demographics and comorbidity profiles continue to strongly support OSA as a risk factor for CAD.

Dr. Peker said that not only is the prevalence of OSA "surprisingly high," these patients do not always show typical symptoms such as sleepiness.
"We found that the prevalence of OSA is 64% in the CAD population. This is very high. Hypertension is 58% and obesity 28% [in this population], so OSA is much more common than more conventional risk factors. Of course, these comorbidities probably interact. In fact, CAD patients with OSA have far more comorbidities than CAD patients without OSA," he told Medscape Medical News.

CAD patients with OSA were older than those without OSA (64 vs 62 years; P = .011), had a higher body mass index (29.4 vs 25.5 kg/m2; P = .001), were primarily male (85% vs 76%; P = .018), and had a higher incidence of hypertension (61% vs 48 %; P = .029), diabetes (25 vs 13%; P = .013), and atrial fibrillation (20% vs 9 %; P = .019). Patients with CAD and OSA also had a higher incidence of obesity than those with CAD without OSA (33.7% vs 5.95%).

Dr. Peker looked at both OSA syndrome (or "sleepy OSA," because of daytime sleepiness symptoms) and "nonsleepy OSA." He found that the CAD risk increase was present with both types of OSA.

Between sleepy and nonsleepy OSA patients, there were no differences in the prevalence of comorbidities, except for obesity, Dr. Peker reported. Obesity was more common in sleepy than in nonsleepy OSA patients (43.3% vs 27.9%; P = .002).

Before the commencement of the RICCADSA trial, there was a dearth of randomized controlled trials investigating whether CAD patients are at risk for OSA and, if so, whether their cardiovascular disease would benefit from CPAP therapy for OSA.

Of 1270 revascularized patients, 650 agreed to participate. To date, 64% of these have met the criteria for OSA syndrome, and 480 CAD patients have been enrolled in the trial (Dr. Peker plans to enroll a total of 500 patients). These patients have been randomized into 4 groups of approximately equal size: nonsleepy OSA patients receiving CPAP therapy; nonsleepy OSA patients receiving non-CPAP therapy; sleepy OSA patients receiving CPAP therapy; and CAD patients without OSA.

For one of the secondary end points, adherence to CPAP therapy, "we found that at 1-year follow-up, 70% of sleepy OSA patients with CAD were still using their CPAP. Surprisingly, 60% of nonsleepy or asymptomatic OSA patients were also still on treatment," Dr. Peker said.

Dr. Peker explained that these interim findings have led him to advise patients, whether symptomatic or not, to adhere to CPAP therapy. "If we ask the CAD patients to use CPAP [at the time of revascularization], so far, they appear motivated enough to follow treatment. So CPAP can be a nonpharmacologic treatment as a secondary cardiovascular prevention method."

He expects that the final trial results, due in 2012, will allow CPAP to be defined in terms of its impact as a nonpharmacologic intervention for CAD patients with either symptomatic or asymptomatic OSA. To achieve this, Dr. Peker is evaluating the impact of CPAP treatment on the incidence of cardiac events — including new revascularization, myocardial infarction, stroke, and cardiovascular mortality — over a mean of 3 years in CAD patients undergoing percutaneous coronary intervention or coronary artery bypass grafting.

Allan Pack, MBChB, PhD, professor of medicine and chief of sleep medicine at the University of Pennsylvania School of Medicine in Philadelphia, commended the study authors for conducting a much-needed investigation to determine whether CAD in sleepy and nonsleepy OSA patients will benefit from OSA treatment.

"There is increasing awareness among cardiologists about the importance of obstructive sleep apnea as a risk factor for cardiovascular disease. However, we currently do not have the evidence [from randomized clinical trials] that treatment of obstructive sleep apnea reduces cardiovascular risk."

"Dr. Peker's study is one of the initial studies using a randomized clinical trial design to address this question. It is likely that treatment of sleep apnea with CPAP does offer patients with obstructive sleep apnea a viable nonpharmacologic intervention to reduce the risk of cardiovascular disease," he added.

RICCADSA is supported by the grants from the Swedish Heart and Lung Foundation, the Research Fund at Skaraborg Hospital, the KSS Heart Foundation, the University of Gothenburg, and the ResMed Foundation and ResMed Ltd. Dr. Peker and Dr. Pack have disclosed no relevant financial relationships.

European Respiratory Society (ERS) 2010 Annual Congress: Abstract 5374. Presented September 22, 2010.
my personal experience with non-profits has been that they are as much or more money-hungry than any corporation i've ever dealt with. the difference is that non-profits i've dealt with are sneaky and dishonest about their true ambitions, while corporations just "put it out there" that they're trying to make a buck -- in fact, if they aren't, they can actually be sued by their investors for breach of fiduciary duty -- it's arguable illegal for a corporation NOT to try to maximize profits. which one is more morally suspect? personally, i'd rather know where i stand and side with the guys who are honestly trying to make a buck rather than sneak around doing deals under the table to maintain appearances.

Banyon said:
Yesterday the inimitable Walter E. Williams wrote some wisdom about nonprofits: http://www.jewishworldreview.com/cols/williamns092210.php3
Mike said, " ... it's arguable illegal for a corporation NOT to try to maximize profits ..."

Just a technicality, but a better phrase is "optimize profits".

People who think their goal is to "maximize profits" tend to do extreme things that eventually end up minimizing profits (or maximizing losses!).

As with many things in life, there is some balance in the range of profits where life is better than at either end of the range.
Years ago, sometime between 1985 and 1989 in a Kiplinger Newsletter there was a quote from one of the big 'robber barons', J. P. Morgan or equivalent to the effect that any man who made more than a 10% profit on his customers was screwing them.

Of course, back then there weren't all the "middle men" that there are today. Consider a 10% profit on an item, such as a barrel of corn, from the seed in the ground to the kitchen table in a bowl of corn chowder.

And, of course, today the financial world could never be satisfied w/only a 10% profit.
when is was a security guard protecting a vacated property about 1997 previously occupied by garden product and razor company there were papers left around for anybody to see

on one of the papers it stated unless we make a 400% profit on an item we do not make it they were a razor sharp company
with a two edge sword begining with Wilk

another time as a security guard in an open cast again about 1997 they would sell coal for one penny a ton to their customers and still make a profit and sell @ 10,000 pennys or aprox £100 if my sums the last figure is correct
Quoting:

Sleep apnea leads to heart disease


"Our study reveals that individuals with obstructive sleep apnea are prone to developing an aggressive form of atherosclerosis that puts them at risk for impaired blood flow and cardiovascular events," said U. Joseph Schoepf, director of cardiovascular imaging at the Medical University of South Carolina in Charleston, S.C.



Read more: Sleep apnea leads to heart disease - The Times of India http://timesofindia.indiatimes.com/life-style/health-fitness/health...
Yeah, but this study concentrated on obese OSA patients. What about those of us who are NOT obese?
Judy, I imagine that despite the obesity... those patients that have OSA and are not obese will end up the same way... most patients that I see that are not obese still have the same health comorbidities such as hypertension, type 2 diabetes, etc... osa is hard on the body whether we are fat or not...




Judy said:
Yeah, but this study concentrated on obese OSA patients. What about those of us who are NOT obese?
jnk, How do we know that snoring was the only symptom in these pts. Unless I missed something I did not see that any of these 1050 pts were ever tested for anything other than snoring.

j n k said:
Snoring, alone, may have an adverse effect, it seems . . .

http://heart.bmj.com/content/96/Suppl_3/A83.4
http://www.medscape.com/viewarticle/733336

New study should get the american heart associations attention.

from resmed site

We expect the growth of all of our products to continue to benefit from the vastly under-penetrated and growing sleep-disordered breathing market. The findings from clinical studies continue to demonstrate the importance of diagnosing and treating sleep-disordered breathing (SDB). During the quarter, new 10-year study results published in the Journal of the American Heart Association showed that severe obstructive sleep apnea increased the risk of fatal and non-fatal cardiovascular events two-to five fold and can increase the risk of stroke. Recommendations were made for evaluation of SDB particularly for those with obesity, hypertension, heart disease or drug-resistant hypertension(1). Increasingly, there is evidence coming to light that early intervention in the treatment of SDB may slow or prevent the progression of these co-morbidities. The increase in awareness of the role that SDB plays in these costly and debilitating co-morbidities and in the reduction in workplace safety and productivity, should continue to be a major driver of market expansion."

The scientific method may not works so well after all

At least the way we practice it today. It needs fixing.

This is perhaps the most thought provoking and honest article  I've read in many many years. As part of the peer review  process, I am often amazed at the junk that gets published--and my own bias when I review a paper. 
I think that all scientists and engineers MUST read this and understand the problem and anyone else that is pointing to some research study in order to prove their point.
Don't feel bad if you don't get the problem. It is very complex. But you should try, i think. The root cause of the problem is that people have biases, and they can't be completely objective even in science and engineering. But this bias creeps into science in some really weird ways--and this article describes some of these ways. 


99 said:

from resmed site

We expect the growth of all of our products to continue to benefit from the vastly under-penetrated and growing sleep-disordered breathing market. The findings from clinical studies continue to demonstrate the importance of diagnosing and treating sleep-disordered breathing (SDB). During the quarter, new 10-year study results published in the Journal of the American Heart Association showed that severe obstructive sleep apnea increased the risk of fatal and non-fatal cardiovascular events two-to five fold and can increase the risk of stroke. Recommendations were made for evaluation of SDB particularly for those with obesity, hypertension, heart disease or drug-resistant hypertension(1). Increasingly, there is evidence coming to light that early intervention in the treatment of SDB may slow or prevent the progression of these co-morbidities. The increase in awareness of the role that SDB plays in these costly and debilitating co-morbidities and in the reduction in workplace safety and productivity, should continue to be a major driver of market expansion."

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