22
AASM Membership Sections Newsletter
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Issue #7
Their finding suggests that decreasing nasal airway resistance
with nasal surgery can significantly improve CPAP adherence
(though this was poorly defined). Unfortunately, we don’t know
the duration of follow up or the mean time post-surgery when
CPAP retitration was performed. Also, we need to consider
the possibility of publication bias (as suggested by the authors)
influencing the benefit of nasal surgery in improving CPAP
adherence.
Collen J, Lettieri CJ, and Eliasson A. Postoperative CPAP use
impacts long-term weight loss following bariatric surgery. J
Clin Sleep Med 2015;11(3):213-217.
To evaluate long-term CPAP use and weight loss after gastric
banding, this group followed 22 patients for a mean of 7.2
years. At one-year post-surgery, mean weight loss was 36%
(121.1 ± 50.2 lb) with reduction in AHI from 48.2 ± 32.8 to 24.5
± 18.8 (with one patient having AHI < 5, though pre-surgery
AHI for this patient was not reported). Also of note is that only
36% of patients were using their CPAP at one year (again this
“usage” was not specified). At a mean of 7.2 years post-bariatric
surgery, there was a 10% increase in weight from the one year
follow up, with only 5 subjects (23%) continuing to use CPAP.
They suggest that those who continued to use CPAP had
continued weight loss whereas those who discontinued CPAP
had an average of 4.3 lb weight gain per year.
This study suggests that while patients experience dramatic
weight loss in the first year after gastric banding, most will still
require CPAP therapy. Many patients may gain back some of
the initially lost weight after several years. Interestingly, they
suggest that CPAP use was associated with persistent weight loss
whereas CPAP discontinuation resulted in weight gain. While
this result may be used to encourage our post-bariatric patients
to continue to adhere to CPAP therapy, we must be careful in
attributing the continued weight loss to CPAP use alone. It is
possible that those who continued CPAP therapy were also likely
to adhere to healthy lifestyle modifications as well.
Her research interests include ambulatory
models of sleep care, health access, peri-
operative risk related to sleep disordered
breathing and the relationship between
PTSD and sleep apnea. She is a member
of the VA Sleep Network steering
committee, a group of VA sleep providers
working together to promote high quality
clinical care to standardize programmatic
processes and to develop multisite
collaborative sleep research.
CHAD HAGEN, MD
Dr. Chad Hagen, MD, is Director of the
Oregon Health and Science University
Sleep Disorders Program. He maintains
a busy academic sleep clinical practice,
teaches residents and sleep medicine
fellows while continuing research related
to sleep disordered breathing syndrome
definition and disease detection.
JOHN PARK, MD
Dr. John Park, MD, is an Assistant
Professor of Medicine at the Mayo Clinic
in Rochester, Minnesota. He is the Quality
Chair for the Division of Pulmonary and
Critical Care Medicine. His practice is
primarily in Sleep Medicine and Critical
Care Medicine, which aligns with his clinical
research interests – specifically CPAP
adherence and sepsis management.
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Lee YC, et al. Sleep apnea and the risk of chronic kidney
disease: a nationwide population-based cohort study. Sleep
2015;38(2):213-221.
Using the Longitudinal Health Insurance Database of Taiwan,
they retrospectively abstracted data from 4,674 patients with
sleep apnea and no known kidney disease and compared their
outcome with 23,370 patients without sleep apnea or kidney
disease. Not surprisingly, those with sleep apnea had higher
incidence of hypertension, diabetes, atherosclerotic vascular
disease, hyperlipidemia, nephrolithiasis, chronic hepatitis,
gout, COPD, obesity, and musculoskeletal and connective
tissue diseases. When adjusted for age, socioeconomic
characteristics, region of residence, and comorbid medical
illnesses, hazard ratio for developing chronic kidney disease
(CKD) among those with sleep apnea was 1.4 (95% CI, 1.52 –
2.46) and 2.20 (95% CI, 1.31 – 3.69) for development of end-
stage renal disease (ESRD).
This large cohort study confirms that sleep apnea is an
independent risk factor for development of CKD and ESRD.
Unfortunately, they were not able to stratify this risk based on
severity of sleep apnea. Furthermore, while the mechanism is
likely to be multifactorial, we still need to better understand
the mechanism and the impact of sleep apnea treatment on
the outcome of CKD and ESRD.
Martin MS, et al. Sleep breathing disorders and cognitive
function in the elderly: an 8-year follow-up study. The Proof-
Synapse cohort. Sleep 2015;38(2):179-187.
Using a subset of a prospectively enrolled patient in a larger
study (the PROgnostic indicator OF cardiovascular and
cerebrovascular events – PROOF), the investigators assessed
for a relationship between sleep-related breathing disorders
(SBD) and longitudinal cognitive changes in subjects who
were ≥ 65 years old. 559 subjects underwent a battery of
neurocognitive tests at the time of enrollment. They also
