Up to one-quarter of the adult population in the West is estimated to have obstructive sleep apnea, but only two to four percent are symptomatic, which raises the question of if non-symptomatic patients should be treated.

That dilemma was addressed Monday in session B86 “Should We Treat Asymptomatic Obstructive Sleep Apnea Patients,” which featured six presentations dealing with new research, risk to patients, how to treat elderly patients and compliance to treatment. Mark Goldman, an attorney from New York and an asymptomatic patient with OSA, also spoke about how continuous positive airway pressure treatment made a difference in his life.

Reviewing the latest animal model research and how it could translate into clinical practice was Vsevolod Polotsky, M.D., Ph.D., who is an associate professor of medicine in the Division of Pulmonary Medicine at the Johns Hopkins University in Baltimore. This research shows that intermittent hypoxia is the mechanism underpinning sleep apnea to cardiovascular disease, and it is thought to actuate different pathways to disease. Investigators are also looking at how the hypoxia affects the metabolic syndrome.

Session co-chair Malcolm Kohler, M.D., of the Division of Pulmonary Medicine at University Hospital in Zurich in Switzerland, reviewed data showing how much treatment can benefit patients, and how it also raises a question: should all obstructive sleep apnea patients be treated, if up to 25 percent of the population suffers from it? “That is a lot of patients, so it is an important question,” he said.

Other presentations included in the program focused on how sleep apnea affects cognitive function. Experts also discussed whether traffic accidents are tied to asymptomatic sleep apnea patients.

Finally, the program looked at the importance of getting detailed medical histories in patients over 60 who may suffer from sleep apnea because so many of these patients do not complain of sleep problems. Faculty members also talked about the difficulties in patient compliance when treatment is prescribed because wearing a mask to sleep is not agreeable to many patients.