[News] CPAP DOES NOT CHANGE CARDIAC MORTALITY

[srlevine1]

I was very much surprised to see that the use of CPAP does not appear to improve your resistance to cardiac events. The study is described at WebMD http://www.webmd.com/sleep-disorders/sle...troubles#1 for those wanting to look at the details.

Using a breathing device to treat sleep apnea may help you get a good night's rest, but it might not lower your risk of dying from a stroke or heart condition, a new analysis suggests.

Looking at data from 10 clinical trials, researchers found that apnea patients' risk of cardiovascular-related death remained the same whether or not they used a CPAP (continuous positive airway pressure) machine.

Until now, accepted medical practice has assumed that because sleep apnea can promote high blood pressure, inflammation and thicker blood, treating it should reduce a person's risk of fatal heart problems, the researchers explained in background notes.

In the analysis of nearly 7,300 people with sleep apnea, the investigators found no connection between CPAP use and a reduced risk of heart attacks, stroke or sudden cardiac arrest.

"CPAP for the purposes prescribed doesn't seem to be providing significant improvements in mortality from the variety of cardiovascular diseases we know about," said Bove, a past president of the American College of Cardiology.
That doesn't mean sleep apnea patients should stop using CPAP machines, Bove said, given the fatigue and other health problems that can result from chronic sleeplessness.

Oh Well! Being awake during the day is a reward in itself.

[PaulaO2]

Also from the article (which I wish had provided links to resources)

"If treating sleep apnea reduces cardiovascular events, that's icing on the cake," Bhatt said. But "if someone has sleep apnea, it should be treated for its own sake."

Bove and Bhatt both added that the pool of patients in this analysis remained too small to conclusively rule out any heart benefits from CPAP.

"We can't claim there is benefit right now in terms of cardiovascular event reduction from treating sleep apnea, but this serves as an impetus for future studies that are large and well-designed," Bhatt said. "I don't think it by any means disproves it, and it would be unfortunate if readers walked away saying treating sleep apnea isn't important."

The point they are making is: CPAP is for treating sleep apnea, not for treating heart conditions.

On that we can all agree.

[srlevine1]

I remember being told that the use of a CPAP may reduce the incidence of polycythemia (increased production of red blood cells leading to thicker blood) which could be problematical as it was a "risk marker" for bad things like heart attack, stroke, and kidney disease. He also told me that people with high red blood cell counts are likely to have untreated OSA. I guess the study deals with actual events, not long-term damage?

[ajack]

It seems they all come up with different outcomes. This population study shows good effect with compliant cpap use. A return to near normal population HF risk.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2727690/

apnea is a strong predictor

[CB91710]

The point they are making is: CPAP is for treating sleep apnea, not for treating heart conditions.

On that we can all agree.

Bingo.

Treating apnea is treating apnea.
The fact that weight and physical condition contribute to apnea does not mean that those conditions self-resolve when apnea is successfully treated (note I did not say "cured")

BUT....

Successful treatment of apnea leads to better sleep, which in turn promotes a healthier feeling, which PERMITS a person to increase their physical activity levels, which in turn provide the benefits of improved cardiovascular health.

Treatment of apnea in and of itself MAY help alleviate pulmonary hypertension, but it is not a magic pill that will suddenly correct an enlarged heart and drop BP to a healthy range when the patient is still 100lbs overweight.

[quiescence at last]

If we think of deaths due to sleep apnea, there are two or three separate areas of death events which seem to be definitely affected by apnea and whether it is treated or not.

COMORBID - other things that are either correlated or caused by untreated apnea and hypoxemia.  Clearly cardiovascular diseases, thyroid, and diabetes are in this grouping.  Many, many studies show the correlation, and some show causality.

OBVIOUS AFFECTS OF LACK OF PROPER SLEEP - crashing while napping (with or without passengers), mental incontinence, delirium, depression, other forms of degenerative disease and psychological impacts leading to suicide.

OBVIOUS AFFECTS OF RENEWED ENERGY FROM PROPER SLEEP - higher quality of life, more energy, participation in higher risk events like NASCAR racing, motorcycle touring, Scuba diving, sky-diving, river walks, amusement park rides.

QAL

[gordon090]

I have sleep problem. Dose breathing device really work?

[srlevine1]

I have sleep problem. Dose breathing device really work?

This is probably the wrong area to post as these posts are dedicated to a quite different topic. And, you may wish to be more specific.

What type of sleep problems do you appear to have?
Have you seen a sleep doctor or mentioned these problems to your family doctor?
Have any of your doctors prescribed a sleep study?
Have you taken the FREE Epworth Sleepiness Test -- https://web.stanford.edu/~dement/epworth.html -- and what is your score?

There are so many variables, it is hard to give you a specific answer. However, in general, the answer is breathing assistance devices are effective therapy for a wide range of sleep issues that have a physiological component such as your airway collapsing or incorrect triggering of breathing.

I wish you the best of luck on your quest for answers. You will find friendly helpful people on this forum so don't be afraid to ask questions. But, please provide a little background information to help us understand your issue so that we may respond appropriately.

Best of luck.

[srlevine1]

If we think of deaths due to sleep apnea, there are two or three separate areas of death events which seem to be definitely affected by apnea and whether it is treated or not.

One would think that what you are saying is intuitively obvious -- OSA can hasten your death.

But, many of these studies are backward-looking over large datasets for potential correlations to generate a publishable paper. As one who is working on the parsing of the medical literature, I found that very few death certificates list OSA as a cause of death or even as a contributing cause of death. Plus, many studies have such small sample sizes or are so localized as to be incapable of being extrapolated to a larger patient population. You can't win -- but you take what might be useful to your personal situation, discuss it with your doctor and then try it out after he yawns.