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General Discussion on any topic relating to CPAP and/or Sleep Apnea.
Greendirt
 
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Study: "CPAP machines do not reduce heart attack, strokes"

Postby Greendirt on Sun Aug 28, 2016 6:22 am

CPAP machines do not reduce heart attack, strokes for sleep apnoea sufferers: study

http://www.abc.net.au/news/2016-08-28/c ... atenews_sa

According to the article linked above:

* The Sleep Apnoea Cardiovascular Endpoints (SAVE) study monitored sleep apnoea patients with a pre-existing vascular disease over four years in 89 hospitals in Australia, New Zealand, India, the US, Spain and Brazil.

* The results of the study released this week showed the CPAP treatment made no difference to whether patients had a major cardiovascular event .... the overall risk of future cardiovascular events was not improved by the treatment for sleep apnoea.

* However the study did show the patients who used a CPAP machine experienced quality of life benefits including reduced snoring, reduced daytime sleepiness and better mood.

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Re: Study: "CPAP machines do not reduce heart attack, strokes"

Postby 49er on Sun Aug 28, 2016 6:53 am

Most relevant part:

""It's not clear why that might be, Anderson said. One possibility raised in both the study and an accompanying editorial is that the CPAP group was able to wear the masks only about 3.3 hours per night, a length of time that is consistent with CPAP users in the real world. That may not be enough time to affect the frequency of these cardiovascular events. Or it may be that cardiovascular disease is too difficult to modify in this way once it develops, Anderson said.""

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Re: Study: "CPAP machines do not reduce heart attack, strokes"

Postby Chevie on Sun Aug 28, 2016 7:13 am

It's prevented heart attacks and strokes from slamming me. I am sure that I was headed that way before CPAP.

Of course, I have the good sense to use CPAP all night.

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Re: Study: "CPAP machines do not reduce heart attack, strokes"

Postby Cardsfan on Sun Aug 28, 2016 7:32 am

My Cardiologist has a SLEEP APNEA warning signs poster in his exam room. Of course cpap improves heart health.

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Re: Study: "CPAP machines do not reduce heart attack, strokes"

Postby Julie on Sun Aug 28, 2016 7:38 am

"Of course" :?:

Unless your cardiologist is anything more than a follower (as most would be) of prevailing beliefs, I would not assume anything much.

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Re: Study: "CPAP machines do not reduce heart attack, strokes"

Postby chunkyfrog on Sun Aug 28, 2016 8:19 am

So who THE HELL financed this "study"?
The dental device makers?

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Re: Study: "CPAP machines do not reduce heart attack, strokes"

Postby marnne108 on Sun Aug 28, 2016 8:32 am

As a cardiac patient, this article almost ruined my day until I got to the 3.3 hours of use part. What a disreputable misleading article. If I had read this before I started on CPAP, I probably wouldn't have started treatment because I was not aware of the oxygen desats I was having. Now my oxygen levels are in the 90's all night. This article/study is flawed and misleading. Morning rant over...have a nice day everyone :D

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Re: Study: "CPAP machines do not reduce heart attack, strokes"

Postby BlackSpinner on Sun Aug 28, 2016 8:49 am

3.3 hours? Those are not cpap users! I want to see a study with 8 hours of use.

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Re: Study: "CPAP machines do not reduce heart attack, strokes"

Postby 49er on Sun Aug 28, 2016 8:50 am

chunkyfrog wrote:So who THE HELL financed this "study"?
The dental device makers?


"""The finding surprised scientists from two Australian research institutes who conducted the research, because previous examinations have shown that CPAP seemed to have a positive impact on those problems.

In earlier studies, "the epidemiological data is very strong and the biomarker data is very strong," said Craig S. Anderson, a professor of stroke neurology at the George Institute for Global Health in Sydney, and one of the leaders of the new study. So too is observational research on subjects who use CPAP machines, he said."""

I tried to see if Dr. Anderson had an email address but unfortunately, I couldn't find one. Maybe someone else will have better luck.

49er

PS - Found this general email address,info@georgeinstitute.org.au, that maybe can be used to contact Dr. Anderson if anyone is interested in trying.

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Re: Study: "CPAP machines do not reduce heart attack, strokes"

Postby amenite on Sun Aug 28, 2016 9:01 am

"The Sleep Apnoea Cardiovascular Endpoints (SAVE) study monitored sleep apnoea patients with a pre-existing vascular disease over four years"

Seems like this could also be a case of closing the barn door after the horses have run off. For many (most?) of us here we likely had this condition for 5, 10, 20 years or perhaps longer untreated. Probably doing damage every night along the way that would be difficult or impossible to undo.

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Re: Study: "CPAP machines do not reduce heart attack, strokes"

Postby RobertS975 on Sun Aug 28, 2016 9:30 am

I am a physician and a 2 1/2 year CPAP user. I have raised the issue previously about the lack of science that establishes the effectiveness of CPAP in terms of preventing future disease and lenghthening lifespan. That is not to say that it does not, just that there wasn't any proof that I had seen. Clearly makes ME feel better, and I am very adherent and compliant.

Here is a copy of the Discussion portion of the original article published online in New England Journal of Medicine 8/28/16 AND following that, an editorial in the same issue of the NEJM:

"Original Article Published Online New England Journal of Medicine 8/28/16

DISCUSSION
This secondary prevention trial in adults with cardiovascular disease and obstructive sleep apnea showed that the risk of serious cardiovascular events was not lower among patients who received treatment with CPAP in addition to usual care than among those who received usual care alone. Treatment with CPAP was associated with a greater reduction in symptoms of daytime sleepiness and with improved health-related quality of life, mood, and attendance at work. This study was not powered to provide definitive answers regarding the effects of CPAP on secondary cardiovascular end points, but there was no indication of a significant benefit with respect to any cause-specific cardiovascular outcome.
Three other randomized trials have investigated the effect of CPAP on cardiovascular end points in patients with obstructive sleep apnea.26-28 Two studies — a multicenter study conducted in Spain that compared CPAP with usual care in 725 patients with obstructive sleep apnea who did not have prior cardiovascular disease26 and a single-center study involving 224 patients with obstructive sleep apnea and coronary artery disease who had just undergone revascularization28 — showed no difference in composite cardiovascular end points over several years of follow-up, although in adjusted analyses, both studies reported better outcomes among patients who were adherent to CPAP therapy (≥4 hours per night) than among patients who did not receive CPAP or who used CPAP less than 4 hours per night. The third study involving 140 patients with recent ischemic stroke showed no effect of CPAP on event-free survival over 2 years.27
One important potential limitation of our trial is that, for several of the participating countries, the diagnosis and treatment of sleep apnea were not well established in clinical practice when the trial began. However, before trial recruitment, we expended substantial time and effort in conducting training workshops for investigators and study coordinators. In addition, extensive site monitoring was conducted throughout the trial to ensure a high standard of study conduct.
Participants in the SAVE study who were assigned to CPAP adhered to the treatment for a mean of 3.3 hours per night over several years, which is similar to the mean adherence in other reports of CPAP use in patients who had no or minimal daytime sleepiness29,30 and which is consistent with CPAP use in clinical practice.31 However, although this overall level of adherence to CPAP therapy exceeded the estimates in our power calculations, it may still have been insufficient to provide the level of effect on cardiovascular outcomes that had been hypothesized. For practical reasons and to ensure efficient recruitment and consistency of data across multiple sites, we used a simple screening device (ApneaLink) that was based on oximetry and nasal pressure recordings and used automated algorithms to analyze signals, rather than the conventional standard test for obstructive sleep apnea in which polysomnographic data from an overnight stay in a hospital or clinic are scored manually. The ApneaLink screening device has been shown to be a reliable method for diagnosing moderate-to-severe obstructive sleep apnea.32,33 To mitigate the risk of recruiting patients with predominantly central apnea rather than obstructive sleep apnea, we excluded patients with overt heart failure and patients in whom the nasal pressure signals showed a predominant pattern of Cheyne–Stokes respiration.
In conclusion, in a large group of adults with both cardiovascular disease and moderate-to-severe obstructive sleep apnea, the use of CPAP therapy had no significant effect on the prevention of recurrent serious cardiovascular events, despite significantly reduced sleepiness and other symptoms of obstructive sleep apnea and improved quality-of-life measures.
Presented at the European Society of Cardiology Conference, Rome, August 28, 2016.
Supported by project grants (1006501 [2011–2015] and 1060078 [2014–2016]) from the National Health and Medical Research Council (NHMRC) of Australia and by Respironics Sleep and Respiratory Research Foundation and Philips Respironics. Supplementary trial funding was provided by Fisher & Paykel Healthcare, the Australasian Sleep Trials Network (enabling grant 343020 from the NHMRC), the Spanish Respiratory Society (grant 105-2011 to Drs. Barbe and Mediano), and Fondo de Investigaciones Sanitarias (grant 13/02053 to Drs. Barbe and Mediano). In-kind donations were provided by Respironics for CPAP equipment and by ResMed for sleep apnea diagnostic devices.
Disclosure forms provided by the authors are available with the full text of this article at NEJM.org.
Dr. McEvoy reports receiving research study equipment from Air Liquide; Dr. Antic, receiving lecture fees and payment for the development of educational presentations from ResMed, AstraZeneca, and GlaxoSmithKline and research study equipment from Air Liquide; Dr. Drager, receiving research study equipment from Philips Respironics; Dr. McArdle, receiving honoraria and grant support from ResMed; Dr. Barbe, receiving grant support from ResMed; Dr. Redline, being involved in a clinical trial supported with funds from Jazz Pharma to her institution; Dr. Wang, receiving consulting and lecture fees from Pfizer, Merck Sharp & Dohme, Sanofi, Novartis, and Daiichi-Sankyo; Dr. Neal, receiving fees for serving on an advisory board from Janssen, honoraria from Janssen, Roche, Abbott, Novartis, Pfizer, and Servier, lecture fees from Roche, Abbott, Novartis, Pfizer, and Servier, travel support from Janssen, Roche, and Servier, and grant support from AbbVie, Dr. Reddy’s Laboratories, Merck Schering Plough, and Roche and serving as chair of the steering committee for two ongoing large-scale trials of an SGLT2 inhibitor funded by Janssen and as a member of the steering committee for a third trial funded by Janssen — all honoraria, grants, and travel reimbursements are paid to his institution; Dr. White, receiving fees for serving on an advisory board from Night Balance and consulting fees from Philips Respironics and serving as chief medical officer of Apnicure; Dr. Grunstein, receiving honoraria and travel support from Merck; and Dr. Anderson, receiving fees for serving on advisory boards from AstraZeneca and Medtronic, lecture fees from Boehringer Ingelheim and Takeda, and travel support from Boehringer Ingelheim. No other potential conflict of interest relevant to this article was reported.




Editorial to Follow in Subsequent Post

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Re: Study: "CPAP machines do not reduce heart attack, strokes"

Postby RobertS975 on Sun Aug 28, 2016 9:38 am

amenite wrote:"The Sleep Apnoea Cardiovascular Endpoints (SAVE) study monitored sleep apnoea patients with a pre-existing vascular disease over four years"

Seems like this could also be a case of closing the barn door after the horses have run off. For many (most?) of us here we likely had this condition for 5, 10, 20 years or perhaps longer untreated. Probably doing damage every night along the way that would be difficult or impossible to undo.


And I also think it is important to realize that in many of us, not all, but a healthy majority of us, not only have we had OSA for years prior to diagnosis and treatment, but we have a collection of other maladies and co-morbid conditions that also need to be enetered into the equations. We have obesity, diabetes and metabolic syndrome, any of which can strongly contribute to future adverse health events.

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Editorial Accompanying Article in NEJM

Postby RobertS975 on Sun Aug 28, 2016 9:40 am

Sorry, meant to post this in this thread, inadvertantly started a needless new thread. So here is the editorial:

From New England Journal of Medicine Online 8/28/16

NEJM Editorial Accompanying Original Scientific Article:

Obstructive sleep apnea is a common disorder that has been associated with an increased risk of cardiovascular disease.1 Continuous positive airway pressure (CPAP) is frequently prescribed in patients with obstructive sleep apnea and is effective in reversing hypoxemia and upper airway obstruction. Meta-analyses of randomized trials have shown that CPAP therapy elicits significant reductions in systemic arterial pressure, and the effect is greater with higher adherence.2,3Observational studies have shown significantly fewer cardiovascular events in patients adherent to CPAP therapy than in those who are not adherent,4,5 but the need for large trials has lingered.
The Sleep Apnea Cardiovascular Endpoints (SAVE) trial, the results of which are now reported in the Journal by McEvoy et al., is therefore an important and welcome addition to the field.6 Patients with a history of coronary artery disease or cerebrovascular disease and moderate-to-severe obstructive sleep apnea were randomly assigned to receive CPAP plus usual care (CPAP group) or usual care alone (usual-care group). In the primary analysis performed in the intention-to-treat population (1346 patients in the CPAP group and 1341 patients in the usual-care group), the use of CPAP did not result in a lower rate of the prespecified primary end point (a composite of death from cardiovascular causes, myocardial infarction, stroke, or hospitalization for unstable angina, heart failure, or transient ischemic attack) than usual care alone (hazard ratio with CPAP, 1.10; 95% confidence interval [CI], 0.91 to 1.32; P=0.34). The lack of a significant effect was observed in multiple prespecified subgroups. Despite the negative result for the primary end point, CPAP had a significant beneficial effect on quality of life, mood, daytime sleepiness, and work productivity.
This trial raises several issues. One major issue is whether the results were negative because obstructive sleep apnea does not have clinically significant adverse cardiovascular effects — and thus any treatment would be ineffective in reducing cardiovascular events — or because the patients did not use CPAP for a long enough duration each night to derive cardiovascular benefits. Given the substantial human and animal data that have consistently documented links between obstructive sleep apnea and cardiovascular health, we suspect that it may be the latter. In the SAVE trial, the mean duration of CPAP adherence was only 3.3 hours per night, which is probably less than half the time the patient was asleep. This dose of CPAP may not be adequate to prevent cardiovascular events. In a prespecified propensity-score–matched analysis, 561 patients who used CPAP for more than 4 hours per night were compared with a control group of patients who received usual care alone. Although one must interpret these data cautiously, given the potential for additional confounders, there was a trend toward a slightly lower risk of a primary end-point event in the CPAP group (hazard ratio, 0.80; 95% CI, 0.60 to 1.07; P=0.13), and the risk of a cerebrovascular event was significantly lower in the CPAP group (hazard ratio, 0.52; 95% CI, 0.30 to 0.90; P=0.02). The potential benefit in patients who were adherent to CPAP therapy is consistent with the findings from two other randomized trials that did not show a lower risk of cardiovascular events in the intention-to-treat analyses but showed a significantly lower risk of cardiovascular events in on-treatment analyses.3,7
Another related issue may be the timing of CPAP; when used in the beginning of the night, CPAP may be less effective than when used later in the night. In many of the trial patients, CPAP may not have been in use during rapid-eye-movement (REM) sleep, the sleep stage that predominates in the early morning hours. This is a concern because apneic or hypopneic events that occur during REM sleep are longer, with greater oxygen desaturation, than those that occur during non-REM sleep; moreover, events that occur during REM sleep have a significantly stronger association with hypertension.8,9
To maximize enrollment, the investigators recruited participants from a variety of geographic locations that had limited resources. They took a pragmatic approach and performed a diagnostic test for obstructive sleep apnea (using a home sleep-study screening device [ApneaLink; ResMed]) that is much simpler to perform than polysomnography. However, it is possible that the limited resources at certain participating sites may have affected adherence to CPAP therapy and the trial results, given that the mean duration of adherence was lower than in other studies.3,10
Finally, we appreciate that choosing to conduct a secondary prevention trial allowed for a smaller sample size, because rates of cardiovascular events would be higher than rates in a primary prevention trial. However, CPAP may have limited effect in patients with well-established cardiovascular disease. Also, because of recruitment challenges, the investigators revised their original sample-size calculation. The reestimation, however, was based on data from a meta-regression that included mostly primary prevention studies rather than secondary prevention studies. Although it seems doubtful that the recruitment of more patients would have changed the results of the primary analysis, it may have made the results for the patients who were adherent to CPAP therapy clearer.
What do these results mean for clinical practice? We believe that for symptomatic patients with obstructive sleep apnea, a trial of CPAP should be offered. It would also be prudent to offer CPAP to patients with obstructive sleep apnea and severe hypoxemia during sleep regardless of symptoms — these patients were excluded from the SAVE trial. However, on the basis of the results from the SAVE trial, prescribing CPAP with the sole purpose of reducing future cardiovascular events in asymptomatic patients with obstructive sleep apnea and established cardiovascular disease cannot be recommended.6 Whether increased adherence to CPAP therapy can lead to better cardiovascular outcomes requires further investigation. Ongoing clinical trials such as the ISAACC study (ClinicalTrials.gov number, NCT01335087) will shed further light on the effect of CPAP in nonsleepy patients with obstructive sleep apnea and acute coronary syndromes. Furthermore, although improving CPAP technology to maximize adherence is important, we believe that there is also a need for novel treatment options that allow for better adherence.

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Re: Study: "CPAP machines do not reduce heart attack, strokes"

Postby chunkyfrog on Sun Aug 28, 2016 10:00 am

The only thing the IDIOTIC study proves is that 3.3 hours a night is NOT ENOUGH!
I need at least 7 hours; 8 is even better.

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Re: Study: "CPAP machines do not reduce heart attack, strokes"

Postby ChicagoGranny on Sun Aug 28, 2016 10:03 am

marnne108 wrote:As a cardiac patient, this article almost ruined my day until I got to the 3.3 hours of use part. What a disreputable misleading article. If I had read this before I started on CPAP, I probably wouldn't have started treatment because I was not aware of the oxygen desats I was having. Now my oxygen levels are in the 90's all night. This article/study is flawed and misleading. Morning rant over...have a nice day everyone :D


When I visited a friend in the cardiac unit with a heart attack, there was a large sign beside the door entering the unit. The sign listed the symptoms of sleep apnea and asked people to think whether they or any family members or friends had symptoms. It went on to say you can avoid a stay in the cardiac unit by treating your sleep apnea.

And, my friend was told to get a sleep study as soon as he recovered from surgery which placed two stents. He did, test was positive, and he now uses CPAP every night, all night.

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