Evolutionary medicine

[Guest dogeatdog12]

Hi guys

 

are you guys taught evolutionary medicine in medical school. I always wanted an MD/PhD doing research in evolutionary medicine. But it's not always considered to be part of the medical curriculum.

 

Can anyone elaborate.

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<username>Ian Wong</username>

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<pagetext>Here's a neat article published in today's Globe and Mail. It describes a small study examining the relationship between obstructive sleep apnea and congestive heart failure, which was published in the New England Journal of Medicine.

 

OSA, or obstructive sleep apnea, is often related to obesity, and individuals with large amounts of redundant tissue in their necks and oropharynx are at high risk for this disease. When these individuals sleep, their musculature relaxes and this causes the upper airway to fall back on itself and obstruct airflow. When this happens, these individuals stop breathing (medically described as apnea) until the lack of oxygen and carbon dioxide buildup causes them to awaken and once awake, their musculature tightens and opens up the airway again.

 

Individuals with severe OSA may wake up hundreds of times per night, and therefore are chronically tired, often irritable and have poor concentration, and are often drowsy throughout the day.

 

A non-surgical treatment for this is CPAP, which is a face mask attached to a pressurized air source. When the CPAP mask is strapped onto your face, air is blown into your mouth at pressure, so even when you fall asleep and your muscles relax, this air pressure is enough to force the airway open again and allows oxygen to get into the lungs. The result is that people are often able to sleep through the night once they learn to tolerate sleeping with a mask on.

 

Anyway, this study discusses a strong link between OSA and CHF, which is interesting in that both of these conditions are fairly common ones, and yet no one has previously drawn this corollary. Of relevance to ENT doctors is that there are surgical treatments for OSA (if patients cannot learn to tolerate the CPAP, or if the CPAP is ineffective). Anyway, I think it's an interesting article.

 

Ian

 

 

www.globeandmail.com/serv.../TPHealth/

 

Congestive heart failure retreats

 

By ANDRÉ PICARD

Thursday, March 27, 2003 - Page A15

 

A simple treatment for sleep apnea can dramatically reverse the debilitating symptoms of congestive heart failure, Canadian researchers have discovered.

 

The remarkable finding, published in today's edition of the New England Journal of Medicine, could revolutionize the treatment of congestive heart failure, a costly and deadly condition that affects almost half a million Canadians.

 

It adds tremendous weight to the growing body of evidence that sleep apnea -- sleep disorder characterized by snoring and restlessness -- is not a benign condition but one that has life-threatening consequences.

 

"This is a beauty, a stunning finding that has real-life implications," said Douglas Bradley, head of the sleep-research laboratories at Toronto General Hospital and lead author. "We can use this information to treat patients today."

 

A person suffering from sleep apnea repeatedly stops breathing during sleep long enough to decrease the amount of oxygen in the blood and brain and to increase the amount of carbon dioxide. It is this chronic poisoning with carbon dioxide that is believed to increase greatly the risk of heart disease.

 

The treatment is simple and inexpensive, an approach called continuous positive airway pressure. Patients use the CPAP device and a breathing mask; the air pumped into the mouth and nose prevents the involuntary lapses in breathing that plague sufferers of sleep apnea.

 

Almost 500,000 people in Canada suffer from congestive heart failure, a condition that occurs when the heart muscle weakens and dies, leaving the heart unable to properly pump blood.

 

About one-third of people with congestive heart failure have sleep apnea. That is six times the number who have sleep apnea in the general population.

 

Noel Bates, a retired lawyer from Creemore, Ont., was diagnosed with congestive heart failure in October, 2000. He had no serious symptoms aside from tiredness, but the condition of his heart deteriorated to the point where he was going to need a transplant.

 

Then, during a visit to his cardiologist in July, 2001, Mr. Bates was asked whether he snored. "My wife of 40 years says I most certainly do," he replied.

 

He was asked to join the sleep-apnea study. During testing, he learned that he stopped breathing, on average, 125 times a night. That was putting a tremendous stress on his heart.

 

The first night he used the CPAP device, the effect was immediate. "My wife thought I was dead because I wasn't snoring," Mr. Bates said. When he awoke, after his first restful sleep in years, he felt reinvigorated.

 

More important, follow-up tests showed his heart was markedly stronger, able to pump blood better than it had for years. He no longer needed a heart transplant. The congestive heart failure was all but gone.

 

Today, Mr. Bates skis, snowshoes regularly and routinely does four-hour hikes. "We are actually reversing heart failure, something that no one thought was possible," Dr. Bradley said.

 

The Toronto study was small, with only 24 patients. But each of the 12 congestive-heart-failure patients in the trial who used the CPAP device had a similar turnabout. The study had to be discontinued because given the early results, it was considered unethical to deny the treatment to the 12 patients without the CPAP device.

 

"This treatment should work for everyone who has a combination of sleep apnea and congestive heart failure," Dr. Bradley said. The machine, unlike drug treatments, has no side effects.

 

A CPAP device, which is about the size of a laptop computer, costs about $1,500.

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