Weight Loss & Sleep Apnea – How NPR Got it Wrong

This morning I read an article about treating sleep apnea that just about drove me crazy.

It is titled: “Lose Weight Before Trying Other Sleep Apnea Treatments, and it was posted by NPR on Facebook, as well as on their website.  It got so many things wrong that I almost don’t know where to begin.

Let’s start with the title, which is supposed to summarize the recommendations of a just published American College of Physicians Clinical Practice Guideline. In the Guideline, the ACP concludes, “all overweight and obese patients diagnosed with OSA should be encouraged to lose weight”. It does NOT say that this should be done instead of, or prior to, treating the underlying disease. Indeed, most experts in the field acknowledge that improving a patient’s sleep accelerates and facilitates weight loss. Weight loss results from improvements in diet, exercise, and sleep. Treating sleep apnea is often the catalyst that allows a patient to lose weight (and that weight loss then tends to help improve the sleep apnea). So sleep apnea treatment typically needs to be part of the weight loss strategy – not the other way around!

Next, the article states that in order to get diagnosed with OSA, patients “need to go to a sleep clinic and do an overnight test for apnea”.  While this statement was undoubtedly true as recently as a few years ago, new technology allows many patients to undergo sleep apnea testing at home. These home-based sleep studies are more convenient, less expensive, and more representative of a typical night’s sleep than lab based studies.  As a result, they are rapidly becoming the standard of care.

Next, the article discussed CPAP, and states that “as many as one-third of people bail on CPAP”. Actual experience is bleaker than that.  In reality, using criteria as loose as just wearing the device 5 hours per night, 5 nights per week, as few as 45% of patients actually “comply”. So while effective, CPAP is clearly not an acceptable solution for millions of OSA sufferers.

The article discussed procedural treatment of sleep apnea by simply lumping all procedures together as “surgery”, and saying that “surgery didn’t help most people”. This is not what the ACP Guideline says. Instead, it criticizes the quality of the surgical literature, saying that the use of different design methods and outcome measures makes “it difficult to ascertain the benefit of surgery for OSA treatment”.  Nowhere does the NPR article mention minimally invasive, multilevel therapy, which is rapidly becoming the standard of care among ENT physicians, nor does it mention several other, newer devices that have shown promise in treating OSA in appropriate patients.

At the end of the day, here is what I know to be true about treating sleep apnea. This insight comes from nearly 20 years of treating patients in the real world, listening to their feedback, and monitoring their progress. There is no perfect solution. But there are a variety of treatment options. If CPAP is a good solution for a particular patient, that’s great! If it isn’t, the patient still needs to be treated. And because sleep apnea typically results from airway compromise at more than one anatomic site, procedural therapy must be multi-level. Our job, as treating physicians, is to fit the solution to the patient – to find the set, or sets, of compromises that best meets the patients’ needs. What matters is helping the patient to get healthier, restorative sleep – and quite often, that better sleep is what allows the patient to actually lose weight!

 

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