Improved Outcomes in Asymptomatic Obstructive Sleep Apnea

This study enrolled 1522 randomly selected, employed research subjects and observed them for 2 decades. The goal of WSCS was to answer one aspect of a US Congressional mandate to determine the overall public burden of sleep d isorders. The WSCS had a surprising finding: mild OSA was seen in 17% of adults, and, most concerning, 6% of adults had moderate to severe OSA. The WSCS finding most relevant to the current USPSTF recommendation statement is that only 35% of WSCS participants with moderate OSA and 37% of participant s with severe OSA reported excessive daytime sleepiness, the cardinal daytime symptom of OSA. This suggests that there is a significant number of individuals with moderate to severe OSA and that more than half of these patients are either asymptomatic or do not recognize their symptoms. The WSCS adj usted hazard ratio for all-cause mortality in untreated severe OSA vs no OSA was 3.0, and for cardiovascular mortality, including stroke, it was 2.9. This hazard ratio was not significantly changed by the presence or absence of excessive daytime sleepiness. The use of continuous positive airway pres sure (CPAP) was associated with improved all-cause and cardiovascular mortality, although compliance with therapy was assessed by verbal report. Of note, retrospective patient self-reports are likely to be overestimates compared with objective CPAP machine downloads because patients tend to exaggera te actual use. Whether the Kaplan-Meier estimates of survival probabil...
Source: JAMA Neurology - Category: Neurology Source Type: research