ABSTRACT
Recent data from the cardiovascular studies in persons with obstructive sleep-disordered breathing (OSDB) challenge us to reconsider how we define ‘‘successful’’ therapies for OSDB (1-3); at the same time, these data substantiate the need to develop novel therapies for this disease. OSDB is an independent risk factor for hypertension (1), myocardial ischemia, congestive heart failure, and stroke (2,3). The need to treat this highly prevalent disease is now more apparent than ever. Results of these studies, however, pose a great challenge to physicians caring for persons with OSDB. Specifically, the relative risk for myocardial ischemia and congestive heart failure increases sharply for persons with an apnea/hypopnea index (AHI) up to 5 events per hour and then levels off. Thus, it would seem that the target AHI after therapy should be under 5, and that lowering an AHI from severe to moderate levels, e.g., from 60 to 20 events per hour, may not reduce the relative risk of all types of cardiovascular morbidity. Certainly, follow-up studies must be performed to substantiate the above relative risks, and we must determine how effective present therapies are in reducing cardiovascular risk. In the interim, however, we are obliged to consider novel therapies.
