“Most clinicians, and even experts in the sleep apnea world, have not typically focused on fat in the tongue for treating sleep apnea,” said Richard Schwab, MD, chief of Sleep Medicine. “Now that we know tongue fat is a risk factor and that sleep apnea improves when tongue fat is reduced, we have established a unique therapeutic target that we’ve never had before.”
From the research article abstract:
Weight loss reduced volumes of several UA soft tissues in persons with obesity and OSA. Improved AHI with weight loss was mediated by reductions in tongue fat. New treatments that reduce tongue fat should be considered for patients with OSA.
- Stephen H. Wang, Brendan T Keenan, Andrew Wiemken, Yinyin Zang, Bethany Staley, David B. Sarwer, Drew A. Torigian, Noel Williams, Allan I Pack, Richard J Schwab. Effect of Weight Loss on Upper Airway Anatomy and the Apnea Hypopnea Index: The Importance of Tongue Fat. American Journal of Respiratory and Critical Care Medicine, 2020; DOI: 10.1164/rccm.201903-0692OC
Wait for it. A plethora of diet and weight loss books for your tongue.
In a five-year study of nearly 11,000 people, those with obstructive sleep apnea had a higher risk of sudden cardiac death. At greatest risk were those aged 60 and older with moderate to severe apnea (20 episodes an hour).
When their oxygen saturation levels dipped below 78 percent — preventing air from flowing into the lungs — their risk increased by 80 percent.
Memo to Underwriters:
In case anyone asks why we are so harsh on untreated OSA quote this study.
Article link here.
Link to the study abstract here.
During an average follow-up of 5.3 years, 142 patients had resuscitated or fatal SCD (annual rate 0.27%). In multivariate analysis, independent risk factors for SCD were age, hypertension, coronary artery disease, cardiomyopathy or heart failure, ventricular ectopy or nonsustained ventricular tachycardia, and lowest nocturnal O2sat (per 10% decrease, hazard ratio [HR]: 1.14; p = 0.029). SCD was best predicted by age >60 years (HR: 5.53), apnea-hypopnea index >20 (HR: 1.60), mean nocturnal O2sat <93% (HR: 2.93), and lowest nocturnal O2sat <78% (HR: 2.60; all p < 0.0001).
In a population of 10,701 adults referred for polysomnography, OSA predicted incident SCD, and the magnitude of risk was predicted by multiple parameters characterizing OSA severity. Nocturnal hypoxemia, an important pathophysiological feature of OSA, strongly predicted SCD independently of well-established risk factors. These findings implicate OSA, a prevalent condition, as a novel risk factor for SCD.
Researchers in Connecticut have found that obstructive sleep apnea (OSA) in patients with atrial fibrillation (AF) appears to be an independent predictor of stroke.
via Obstructive Sleep Apnea, Atrial Fibrillation, and Stroke | Physician’s Weekly.
Untreated Sleep Apnea Boosts Risk of Heart Disease, Stroke | Medpage Today.
Compared with OSA-negative patients, untreated OSA was associated with an 86% higher mortality risk (adjusted hazard ratio 1.86, 95% CI 1.81 to 1.91), and treated OSA was associated with a 35% higher mortality risk (aHR 1.35, 95% CI 1.21 to 1.51), wrote Miklos Z. Molnar, MD, PhD, of the University of Tennessee Health Science Center in Memphis, and colleagues, in the journal Thorax.
Untreated OSA also was associated with a 3.5 times higher risk of incident coronary heart disease (aHR 3.54, 95% CI 3.40 to 3.69), and a 3.5 times higher risk of incident strokes (aHR 3.48, 95% CI 3.28 to 3.64), while treated OSA was associated with a threefold higher risk of incident CHD (aHR 3.06, 95% CI 2.62 to 3.56) and 3.5-fold higher risk of incident strokes (aHR 3.50, 95% CI 2.92 to 4.19). The risk of incident kidney disease also was significantly higher in untreated (aHR 2.27, 95% CI 2.19 to 2.36) and treated OSA (aHR 2.79, 95% CI 2.48 to 3.13).
Several studies have suggested that obstructive sleep apnea contributes to the development of left ventricular systolic and diastolic dysfunction and, possibly, heart failure. Note that this study indicates that moderate-to-severe sleep apnea can cause structural and functional changes in left ventricular function comparable to that seen in hypertension and, further, these abnormalities significantly improve following CPAP therapy.
via Medical News:Apnea Treatment Gets Heart Back in Shape – in Cardiovascular, CHF from MedPage Today.
The connection between OSA and SCD is getting stronger according to a recent study by the Mayo Clinic. This information has profound implications for how life underwriters approach this combination of impairments. When I started in the profession last century, not much thought (or rating) was given to OSA. Times have changed and we now know more about the risk.
Will we use this new data or once again succumb to market forces?