Today’s lectures encompassed a wide range of new developments in sleep disorders as well as non-surgical treatment of obstructive sleep apnea. Dr. Allan Pack discussed important papers published over the past year, including a number of studies published from a Spanish collaboration of sleep medicine centers showing that untreated severe obstructive sleep apnea was associated with increased mortality from cardiovascular disease in older adults (over the age of 60 years). This study was unique in being one of the few studies specifically focused on older adults, and it showed that the cardiovascular health effects of sleep apnea may be similar to those seen in young and middle-aged adults (other studies have provided conflicting evidence). The Spanish group published another study showing that one aspect of sleep apnea, the share of sleep time with low oxygen saturation, was associated with the development of cancer in those under the age of 65 years.
Dr. Gary Foster from Temple University delivered two lectures concerning the worldwide obesity pandemic and non-surgical obesity treatment. He discussed a paper published just this year showing that obesity increased the risk of mortality only at markedly elevated levels (body mass index above 35 kg/m2). Importantly, mortality is not the only adverse sequellae of obesity, as individuals with lesser degrees of obesity (body mass index 30-35 kg/m2) are are at increased risk of a number of health conditions, including cardiovascular disease, diabetes, and orthopedic issues. He highlighted the encouraging results of trials for 2 medications: phentermine/topiramate (Qysmia) and lorcaserin (Belviq; 2020 UPDATE: withdrawn from the US market because of concerns over cancer risk). Dr. Noel Williams from the University of Pennsylvania discussed surgical treatment of obesity and the impressive results that bariatric surgery can achieve in improving sleep apnea in cases of marked obesity.
Dr. Ilene Rosen from the University of Pennsylvania discussed the rationale and use of positive airway pressure, the first-line treatment for moderate to severe obstructive sleep apnea. She discussed newer equipment and technologies, including better masks, expiratory pressure relief (such as C-Flex), and automatically titrating pressure machines (such as AutoPAP). Although these can be very helpful for some patients, there are still a substantial number of patients remain unable to tolerate positive airway pressure therapy in spite of our best efforts.
Dr. Atul Malhotra spoke about new medical treatments for sleep apnea. In addition to a brief discussion of their research that may pave the way for medications as treatment, he also summarized the evidence regarding hypoglossal nerve stimulation, expiratory positive airway pressure therapy (sold as Provent), and oral pressure therapy (sold as Winx). The evidence in support of these is in various stages, and additional research will determine what patients may respond best to these various options.
Finally, Dr. Marc Raphaelson provided an excellent breakdown of the complex and daunting world of reimbursement for the evaluation and treatment of our patients, informing us as physicians how best to advocate for our patients who may require more than the standard approaches.