Speaker: Dr. Renata Riha  & Dr. Christopher Turnbull

This session examines the cardiometabolic consequences of obstructive sleep apnea (OSA).

 In Part 1, Dr. Christopher explores the pathophysiological link between OSA and cardiovascular disease, emphasizing that intermittent hypoxia—not sleep fragmentation—drives daytime blood pressure elevation. He reviews CPAP's modest blood pressure effect, strongest in resistant hypertension, and the neutral cardiovascular outcomes in major RCTs like SAVE. New risk stratification tools such as hypoxic burden and symptom phenotypes (e.g., sleepy patients at highest risk) are discussed. He also presents GLP-1 agonists (e.g., tirzepatide) as an emerging therapy that reduces AHI by ~50% and improves cardiovascular markers. 

In Part 2, Dr. Renata Riha presents two contrasting cases: a 55-year-old woman with severe OSA who suffered a stroke before starting CPAP, and an asymptomatic young soldier with severe OSA but no sleepiness, returned to duty after normal wakefulness testing. She challenges the ecological fallacy in applying group trial data to individuals, questioning whether treatment decisions should be driven by AHI alone or by symptoms and comorbidities.