5 ms·

The prevalence of apnea is likely highly over-estimated. ResMed and Philips, who both make billions off of CPAP, push these high figures. Measures of OSA (Obst

The prevalence of apnea is likely highly over-estimated. ResMed and Philips, who both make billions off of CPAP, push these high figures. Measures of OSA (Obstructive sleep apnea) are somewhat poor, more focused on the amount of pauses in breathing, rather than oxygen desaturation, which is the secondary measure. Note, you don't breath 100% of the time when you're awake either. I work in sleep and neurotech, and at a large sleep conference last year, a talk was given about better methods to measure apnea. It was clear these measures would have significant challenges in being adopted because it would result in less people being diagnosed as needing CPAP. Lastly, the impact of CPAP in improving cognitive function is inconclusive [1]. Not that it doesn't have an affect. It does in some people, but not in others. [1] https://www.sciencedirect.com/science/article/abs/pii/S1389945724003903 https://www.sciencedirect.com/science/article/abs/pii/S13899...

aorloff 1y ago
Did anyone report on reductions in sleep apnea due to GLP-1s ? I would imagine that the introduction of effective weight loss meds en masse might change the trajectory of more than a few sleep apnea sufferers
- reverendsteveii 1y ago
  I have OSA and I haven't taken GLP-1 agonists but I've taken the road they put a person on. 50 pounds ago I was averaging around 15 apnic/hypopnic events per hour, now it's less than 10. My doctor told me that I may as well keep using my CPAP because it seems to help and it's already paid for but that if these were the results of my initial sleep study he wouldn't have prescribed one to me.
teamonkey 1y ago
Slightly off-topic, but as someone in the field, what is your opinion of the apnea-detecting functionality of smart watches?
- reverendsteveii 1y ago
  I'm in the field, I built the software in your cpap machine and home sleep study that we use to test and treat them. It comes down to microarousals, which is where you wake up just enough to disrupt the sleep cycle without actually becoming consciously aware. A smart watch can detect that, and it can also measure o2 saturation in your blood. To my mind that means that a smart watch can determine whether your sleep is interrupted and by how much, and even gather some evidence that apnea could be among potential causes (there are other ways to have low o2 saturation) but I don't think it can actually diagnose.
reverendsteveii 1y ago
When I did my sleep study they monitored my o2 saturation. it's true that there's no ongoing monitoring during treatment though.
- pedalpete 1y ago
  I didn't mean to imply they don't monitor o2 in studies, but the metrics of how apnea is diagnosed relies heavily on hypopnea independent of oxygen desaturation.
Llamamoe 1y ago
Respectfully... how do you work in the field, while being so wrong? Oxygen desaturation correlates with long-term metabolic outcomes, but correlates very poorly to day-to-day symptoms. The actual primary cause of symptoms in SDB is microarousals resulting from increased respiratory effort, and sleep studies using 3%-or-arousal criteria report MUCH higher OSA rates than the commonly used hypoxia+reduction in flow criteria, while also having a much higher correlation with symptoms(>60% vs ~17% for AHI), and the problem is not over, but under- diagnosis since people with relatively few apneas(e.g. UARS patients) are rarely diagnosed correctly. Also, (optimally) healthy people DO breathe 100% of the time during sleep- breathing during sleep is controlled by a different system while awake, and is extremely regular during NREM sleep, with REM merely introducing noise to breath amplitude. Any and all pauses in breathing are caused by sleep disruption. The only reason why it seems like apnea-based criteria are oversensitive is because obese, older men often DON'T wake up from airway collapse and may be fine at 5, 10, or even 15 AHI. For everyone else, it's possible to have debilitating symptoms at 4 because the actual Respiratory Disturbance Index is 20+. Goddammit man. People like you are why so many go their entire lives unable to find treatment. If you're working in the field, educate yourself about it. Ugh.
- reverendsteveii 1y ago
  This, precisely. An apneic event is defined as 10 seconds of pause in your breathing (https://www.sleepfoundation.org/sleep-apnea/ahi https://www.sleepfoundation.org/sleep-apnea/ahi). Go ahead and hold your breath for a slow count of 10 (set a timer or do the mississippis or alligators or locomotives or whatever other 4 syllable phrase you need to do in order to make it a real, honest 10 seconds. it's long enough to be noticeably uncomfortable). You don't casually do that during the day. Sleep apnea is defined as you doing that 10-15 times per hour, and your sleep study also measures microarousals to correlate (source: I built the damn things for a living a few years back). Also they do monitor o2 sat in children at least, cyanosis is one of the ways they diagnose apnea in children. Way too many professionals in the field thinking that they're the first person to think about something when literally millions of people think about this same thing all day every day.

aorloff 1y ago

Did anyone report on reductions in sleep apnea due to GLP-1s ? I would imagine that the introduction of effective weight loss meds en masse might change the trajectory of more than a few sleep apnea sufferers

reverendsteveii 1y ago
I have OSA and I haven't taken GLP-1 agonists but I've taken the road they put a person on. 50 pounds ago I was averaging around 15 apnic/hypopnic events per hour, now it's less than 10. My doctor told me that I may as well keep using my CPAP because it seems to help and it's already paid for but that if these were the results of my initial sleep study he wouldn't have prescribed one to me.

teamonkey 1y ago

Slightly off-topic, but as someone in the field, what is your opinion of the apnea-detecting functionality of smart watches?

reverendsteveii 1y ago
I'm in the field, I built the software in your cpap machine and home sleep study that we use to test and treat them. It comes down to microarousals, which is where you wake up just enough to disrupt the sleep cycle without actually becoming consciously aware. A smart watch can detect that, and it can also measure o2 saturation in your blood. To my mind that means that a smart watch can determine whether your sleep is interrupted and by how much, and even gather some evidence that apnea could be among potential causes (there are other ways to have low o2 saturation) but I don't think it can actually diagnose.

reverendsteveii 1y ago

When I did my sleep study they monitored my o2 saturation. it's true that there's no ongoing monitoring during treatment though.

pedalpete 1y ago
I didn't mean to imply they don't monitor o2 in studies, but the metrics of how apnea is diagnosed relies heavily on hypopnea independent of oxygen desaturation.

Llamamoe 1y ago

Respectfully... how do you work in the field, while being so wrong? Oxygen desaturation correlates with long-term metabolic outcomes, but correlates very poorly to day-to-day symptoms. The actual primary cause of symptoms in SDB is microarousals resulting from increased respiratory effort, and sleep studies using 3%-or-arousal criteria report MUCH higher OSA rates than the commonly used hypoxia+reduction in flow criteria, while also having a much higher correlation with symptoms(>60% vs ~17% for AHI), and the problem is not over, but under- diagnosis since people with relatively few apneas(e.g. UARS patients) are rarely diagnosed correctly. Also, (optimally) healthy people DO breathe 100% of the time during sleep- breathing during sleep is controlled by a different system while awake, and is extremely regular during NREM sleep, with REM merely introducing noise to breath amplitude. Any and all pauses in breathing are caused by sleep disruption. The only reason why it seems like apnea-based criteria are oversensitive is because obese, older men often DON'T wake up from airway collapse and may be fine at 5, 10, or even 15 AHI. For everyone else, it's possible to have debilitating symptoms at 4 because the actual Respiratory Disturbance Index is 20+. Goddammit man. People like you are why so many go their entire lives unable to find treatment. If you're working in the field, educate yourself about it. Ugh.

reverendsteveii 1y ago
This, precisely. An apneic event is defined as 10 seconds of pause in your breathing (https://www.sleepfoundation.org/sleep-apnea/ahi https://www.sleepfoundation.org/sleep-apnea/ahi). Go ahead and hold your breath for a slow count of 10 (set a timer or do the mississippis or alligators or locomotives or whatever other 4 syllable phrase you need to do in order to make it a real, honest 10 seconds. it's long enough to be noticeably uncomfortable). You don't casually do that during the day. Sleep apnea is defined as you doing that 10-15 times per hour, and your sleep study also measures microarousals to correlate (source: I built the damn things for a living a few years back). Also they do monitor o2 sat in children at least, cyanosis is one of the ways they diagnose apnea in children. Way too many professionals in the field thinking that they're the first person to think about something when literally millions of people think about this same thing all day every day.