This Article Contradicts Most Sleep Apnea Studies

[Guest]

There was a follow-up article in 2015. Lavie, L, Oxidative stress in obstructive sleep apnea and intermittent hypoxia – Revisited – The bad ugly and good: Implications to the heart and brain, Sleep Medicine Reviews, 2015, 20, 27

It's a very technical article, but what they conclude is that SOA is damaging, but preconditioning the body to deal with decreased oxygen levels can actually be protective for events that result in decreased oxygen levels (for example, heart attack, stroke, COPD, etc). Their TLDR version for practitioners is below.

"Practice points

1) Obstructive sleep apnea (OSA) is associated with oxidative stress which likely contributes to various cardiovascular risk factors and morbidities.
2) In some instances OSA/IH may confer cardio- and neuro-protection by activating mechanisms of ischemic preconditioning. This is particularly evident in patients with cardiovascular morbidity and concomitant OSA, and in mild-moderate OSA.
3) In animal models mimicking OSA a dichotomous effect is noted. Exposure to mild-moderate IH corroborates activation of cardio- and neuro-protection, whereas exposure to severe IH induces damage to these organs.
4) Preconditioning is complex and involves a multitude of molecules, transcription factors, and transduction pathways, and thus is not entirely elucidated. However, it likely involves the cells' ability to maintain homeostatic redox balance by adapting to oxidative stress via upregulation of distinct sets of cytoprotective genes responsible for promoting the cells' antioxidant capacity.
5) Paradoxical data from epidemiological mortality-endpoint studies may support the existence of cardioprotective mechanisms in OSA.
6) New experimental strategies should be implemented in order to identify protective mechanisms in OSA."

[Guest]

By the way, they did not conclude that OSA should not be treated.

Nick Danger

[DeeCPAP]

There was a follow-up article in 2015. Lavie, L, Oxidative stress in obstructive sleep apnea and intermittent hypoxia – Revisited – The bad ugly and good: Implications to the heart and brain, Sleep Medicine Reviews, 2015, 20, 27

It's a very technical article, but what they conclude is that SOA is damaging, but preconditioning the body to deal with decreased oxygen levels can actually be protective for events that result in decreased oxygen levels (for example, heart attack, stroke, COPD, etc). Their TLDR version for practitioners is below.

"Practice points

1) Obstructive sleep apnea (OSA) is associated with oxidative stress which likely contributes to various cardiovascular risk factors and morbidities.
2) In some instances OSA/IH may confer cardio- and neuro-protection by activating mechanisms of ischemic preconditioning. This is particularly evident in patients with cardiovascular morbidity and concomitant OSA, and in mild-moderate OSA.
3) In animal models mimicking OSA a dichotomous effect is noted. Exposure to mild-moderate IH corroborates activation of cardio- and neuro-protection, whereas exposure to severe IH induces damage to these organs.
4) Preconditioning is complex and involves a multitude of molecules, transcription factors, and transduction pathways, and thus is not entirely elucidated. However, it likely involves the cells' ability to maintain homeostatic redox balance by adapting to oxidative stress via upregulation of distinct sets of cytoprotective genes responsible for promoting the cells' antioxidant capacity.
5) Paradoxical data from epidemiological mortality-endpoint studies may support the existence of cardioprotective mechanisms in OSA.
6) New experimental strategies should be implemented in order to identify protective mechanisms in OSA."

Thanks for this guest. You must have read my mind (or email). Is it possible from the data to *eventually* conclude (by extrapolation) that by not treating *some* older people whose hearts seem fit, using a CPAP would reduce existing fitness? Another question: What about the effects of not treating older people and it's effect on cognitive functioning?

[jnk...]

I am not the guest, but I hope you don't mind if I chime in, Dee.

I believe there is NO evidence that PAP EVER reduces fitness.

I believe that good sleep and good breathing (which are what PAP is for) ALWAYS help cognitive functioning.

Organs being adapted to episodes of low O2 is, as far as I can ascertain, good for one thing and one thing only: maybe surviving a cardiovascular event that otherwise could cause death from the the sudden, severe lack of O2 that can occur before any lifesaving interventions can be initiated.

But I don't work in the medical field.

[DeeCPAP]

I am not the guest, but I hope you don't mind if I chime in, Dee.

I believe there is NO evidence that PAP EVER reduces fitness.

I believe that good sleep and good breathing (which are what PAP is for) ALWAYS help cognitive functioning.

Organs being adapted to episodes of low O2 is, as far as I can ascertain, good for one thing and one thing only: maybe surviving a cardiovascular event that otherwise could cause death from the the sudden, severe lack of O2 that can occur before any lifesaving interventions can be initiated.

But I don't work in the medical field.

Thanks, Jnk. What you wrote makes sense, and not using a CPAP to help strengthen the heart of the elderly is a far fetched idea but it *does* show merit in this *one* study of older people with sleep apnea. I wonder what the same study would show if the variable of "cognitive function" were used.

This example comes to mind: Deep sea divers can stay under water for a long time *because* they've conditioned.

Another question about the studies: Have these "older people" who seem to be getting a cardiovascular workout had sleep apnea for a long time, or were they recently diagnosed? Either I missed reading it or it wasn't mentioned in the article.

I'm just thinking out loud...

[cherylgrrl]

As a person who tested out at 106 AHI and whose oxygen saturation went down into the low 70s without xPAP therapy, I don't think I'll tempt fate by stopping therapy. Even though I was completely asymptomatic, I have been happy to use my servo ventilator every night for the last 5 years! (except for 2 nights when I was camping and forgot my battery attachment...)

[jnk...]

Forgoing PAP is not a "cardiovascular workout" or a "deep-sea dive." Sustained hypoxia does damage along with the theoretical "conditioning" (in a very specific medical sense) of some organs.This phenomenon is not "conditioning" in the positive sense of being in good condition; it is "conditioning" in the sense of 'being used to being damaged,' in the context of forgoing PAP.

In severe OSA, with SUSTAINED low O2 levels for long periods of time, the damage done is not ever a good risk to take. It is only a statistical anomaly, in a sense, that a scientific study framed in a particular way apparently found one slight "advantage" in longevity for a population at high risk of death by cardiovascular events, as I read/interpret the study as a layman.

None of this has any value for application for treatment decisions for any easily-identifiable population, as far as clinical practice, IMO.

[DeeCPAP]

As a person who tested out at 106 AHI and whose oxygen saturation went down into the low 70s without xPAP therapy, I don't think I'll tempt fate by stopping therapy. Even though I was completely asymptomatic, I have been happy to use my servo ventilator every night for the last 5 years! (except for 2 nights when I was camping and forgot my battery attachment...)

Cherylgrrl, you were asymptomatic at 106 AHI with oxygen in the low 70's? How'd your doc determine you needed testing? How'd you feel after therapy started?

[Hang Fire]

You-know-who is expending effort to find a rationale to not use CPAP.

[Goofproof]

Forgoing PAP is not a "cardiovascular workout" or a "deep-sea dive." Sustained hypoxia does damage along with the theoretical "conditioning" (in a very specific medical sense) of some organs.This phenomenon is not "conditioning" in the positive sense of being in good condition; it is "conditioning" in the sense of 'being used to being damaged,' in the context of forgoing PAP.

In severe OSA, with SUSTAINED low O2 levels for long periods of time, the damage done is not ever a good risk to take. It is only a statistical anomaly, in a sense, that a scientific study framed in a particular way apparently found one slight "advantage" in longevity for a population at high risk of death by cardiovascular events, as I read/interpret the study as a layman.

None of this has any value for application for treatment decisions for any easily-identifiable population, as far as clinical practice, IMO.

Basically the Candle that burns brighter, burns shorter. The object of doing XPAP is to be able to prolong your health and life. If you have Sleep Apnea XPAP does that! Jim

[DeeCPAP]

I am not the guest, but I hope you don't mind if I chime in, Dee.

I believe there is NO evidence that PAP EVER reduces fitness.

I believe that good sleep and good breathing (which are what PAP is for) ALWAYS help cognitive functioning.

Organs being adapted to episodes of low O2 is, as far as I can ascertain, good for one thing and one thing only: maybe surviving a cardiovascular event that otherwise could cause death from the the sudden, severe lack of O2 that can occur before any lifesaving interventions can be initiated.

But I don't work in the medical field.

Thanks, Guest. Glad you chimed in. What you wrote makes perfect sense. The study seemed to imply that without CPAP the cardiovascular functioning in older people is enhanced. It would seem that if CPAP treatment is used, it would reduce the existing enhancement of cardiovascular functioning. Maybe it's true, maybe not, but it's worth consideration, but only *theoretically*.

Just thought I'd add this last line. It would be dangerous to try to test out the theory, so always use your CPAP!

[D.H.]

So I would listen to this study (if it's interpreted to mean I should not use CPAP)? That means that ignore all the other studies made in the last half century, feel lousy all the time again, loose control of my blood pressure, and put my self at risk for an accident!

[DeeCPAP]

Forgoing PAP is not a "cardiovascular workout" or a "deep-sea dive." Sustained hypoxia does damage along with the theoretical "conditioning" (in a very specific medical sense) of some organs.This phenomenon is not "conditioning" in the positive sense of being in good condition; it is "conditioning" in the sense of 'being used to being damaged,' in the context of forgoing PAP.

In severe OSA, with SUSTAINED low O2 levels for long periods of time, the damage done is not ever a good risk to take. It is only a statistical anomaly, in a sense, that a scientific study framed in a particular way apparently found one slight "advantage" in longevity for a population at high risk of death by cardiovascular events, as I read/interpret the study as a layman.

None of this has any value for application for treatment decisions for any easily-identifiable population, as far as clinical practice, IMO.

Basically the Candle that burns brighter, burns shorter. The object of doing XPAP is to be able to prolong your health and life. If you have Sleep Apnea XPAP does that! Jim

Absolutely! It's also good to have safeguards and do some double-checking to make sure things are okay with one's CPAP treatment because people are human and can make miSTEAKS.

[Captain_Midnight]

Sounds like a (government sponsored?) study made for the purpose of withholding treatment from the aged.
Nuts, I say.

My, your comment is so cynical.

(True, though. Nice analysis.)

[D.H.]

For now, I would not follow any recommendations from this study.

Also, this is an older population, which means those who died at a younger age are "weeded out" of the sample. Perhaps many of those who did not live to be in the sample would have been alive, participated in the study, and greatly changed the results, if they have been using CPAP at an early age!