Dr Patryk Szulakowski graduated from Medical University of Silesia in Poland in 1995.
Patryk was involved in research, presented his work at international conferences (UK, USA) and has been awarded a PhD with distinction from the Medical University of Silesia for his research on COPD, carried out at the Centre for Inflammation Research, University of Edinburgh .
He did his specialist training in Respiratory and General (Internal) Medicine in Glasgow.
Patryk attended Sleep Medicine Courses at the University of Edinburgh and Cambridge and passed an International Sleep Medicine Examination in London in 2013.
Between 2011 and 2017 he worked as a Respiratory Consultant/Lead in Sleep in East and North Hertfordshire NHS Trust (Stevenage, England).
He moved to New Zealand mid April and started working in BOPDHB on 1st May 2017
OSA, CPAP And Cardiovascular Events – Back To Square On
Obstructive sleep apnoea (OSA) is estimated to affect approximately 9% of adults and is associated with elevated risk of serious cardiovascular events, including coronary artery disease, heart failure, stroke and sudden death. It is conceivable that cardiovascular disease is a consequence of progressive inflammation triggered by chronic intermittent hypoxia, sleep fragmentation and arousals.
Clinical presentation of OSA varies between the patients. There are three distinct subgroups: (1) patients with a primary complaint of insomnia, (2) the least symptomatic patients with a high prevalence of cardiovascular comorbidities, and (3) excessively sleepy patients with the highest rate of falling asleep while driving. Despite the heterogeneity of OSA clinical presentation majority of patients have been offered one-size-fits-all approach – treatment with CPAP (Continuous Positive Airway Pressure).
The recently published meta-analysis by Yu and colleagues evaluated the association of CPAP with cardiovascular events and death in adults with sleep apnoea. The conclusion of this meta-analysis was that CPAP treatment did not reduce risks of cardiovascular outcomes or death. There were no associations of CPAP with outcomes for different levels of apnoea severity, follow-up duration, or CPAP adherence.
Apart from proven therapies, such as lipid lowering, antihypertensive and antiplatelet therapy, weight-loss intervention remains a central component of the strategies used to improve the cardiovascular risk-factor profile in patients with obesity and OSA.
It is reasonable to recommend CPAP therapy for the improvement of symptoms in patients with OSA but not for protection against vascular disease or death. Also, it can be argued if asymptomatic patients with cardiovascular comorbidities should be referred for a sleep study.