Modest Improvement of Untreated Severe Sleep-Disordered Breathing in the Middle-Aged and Elderly

Abstract

ObjectiveIt has been reported that untreated sleep-disordered breathing (SDB) deteriorates over time, however this remains contentious. The aim of the present study is to evaluate the clinical course of SDB in middle-aged and older SDB patients, and to identify how relevant factors contribute to the change in SDB severity.MethodsBaseline and follow-up polysomnographic data of 56 untreated SDB patients (mean age, 61.2±5.71) were obtained retrospectively and the mean interval was 62.4±22.0 months. Subgroup analysis was performed based on the baseline severity, and the factors associated with the course of SDB were analyzed.ResultsAt the baseline, 13 subjects were simple snorers, 15 had mild to moderate SDB, and 28 were severe SDB patients. While there was no significant change in apnea-hypopnea index (AHI) as a whole, subgroup analysis showed decrease of AHI in severe SDB patients (43.9±10.6 to 35.6±20.0, p=0.009). The change in supine time percent and baseline AHI were associated with the change in AHI (β=0.387, p=0.003; β=-0.272, p=0.037).ConclusionUntreated SDB did not deteriorate over time with modest improvement in severe SDB. A proportion of severe SDB patients might expect decrease in SDB severity irrespective of changes in sleep position or body weight.

The effects of long‐term continuous positive airway pressure on apnea–hypopnea index change following short‐term that withdrawal in patients with obstructive sleep apnea

“…CPAP therapy significantly decreased AHI in patients with severe OSA; however, as previous studies, a decrease in AHI was also found in untreated severe OSA patients, 11 , 12 which may be related to healthy lifestyle education. The lack of AHI increases in severe patients suggesting a ceiling effect may exist; namely, if AHI reaches a critical point, the mechanism of body protection may be activated, thus sparing them from the effect of severe nocturnal hypoxemia.…”

“…The effect of CPAP treatment on AHI after CPAP withdrawal is unclear, especially in OSA patients screened from the population. Many previous studies have investigated the natural evolution of OSA severity, 11 , 12 , 13 but few studies focus on the effect of CPAP treatment on that in the general population. Active OSA screening and early intervention in the general populations may be an innovative model to decrease OSA severity and improve cardiovascular outcomes.…”