Medical complications of untreated sleep apnea

[palerider]

I don’t expect most people here to understand exactly what a MAD is or does being on a cpap talk forum.

You might be surprised. Many people here that are successfully using cpap have a MAD taking up space in a drawer somewhere.

I’d be curious to hear their stories if they got a real custom made MAD like tap 3 or just one on eBay boil and bit that’s not approved for treatment of osa. The way it is with my insurance where I live is you can’t even get a MAD covered by insurance unless you first try cpap you failed the therapy. Only then will insurance help you pay the cost of a 2000 dollar mouthpiece. Unless you go to a local dentist in your area who wants to make one up for you, you might be able to get it cheaper and outside insurance. Most people probably won’t want to fork over the money to test out something that can’t be trailed and returned like cpap can...the place I’m going to the dentist is a certified board member sleep specialist. Not just a random dentist making oral devices for people coming in.

Well, there's this for starters:

I have one made by a dentist (it is sitting in the cabinet, unused ) the one I have used for the past three years is a boil and bite from ebay (cost less than $2)

[grayghost4]

I’d be curious to hear their stories if they got a real custom made MAD like tap 3 or just one on eBay boil and bit that’s not approved for treatment of osa. The way it is with my insurance where I live is you can’t even get a MAD covered by insurance unless you first try cpap you failed the therapy.

The MAD that I have was made by a dentist qualified for sleep ... paid by Medicare. and they only pay if it is shown to work by a sleep study, which I had and titrated to AHI less than 1 .
To accomplish that they had to adjust it forward so far I could not stand to use it ... I tried adjusting it to a comfort level but never had any success with it. So now I use the boil and bite and it helps with the cpap to control the sleep apnea.

[ravenous28]

I’d be curious to hear their stories if they got a real custom made MAD like tap 3 or just one on eBay boil and bit that’s not approved for treatment of osa. The way it is with my insurance where I live is you can’t even get a MAD covered by insurance unless you first try cpap you failed the therapy.

The MAD that I have was made by a dentist qualified for sleep ... paid by Medicare. and they only pay if it is shown to work by a sleep study, which I had and titrated to AHI less than 1 .
To accomplish that they had to adjust it forward so far I could not stand to use it ... I tried adjusting it to a comfort level but never had any success with it. So now I use the boil and bite and it helps with the cpap to control the sleep apnea.

So your insurance company would only pay for it was proven to work in a sleep study? Did you have to pay anything at all? Was your sleep study free? How did you determine you had to have it titrated to achieve an ahi of 1? How many mm did you have to turn it out? You can’t accomplish that on sleep study like that just turning it up randomly all the way while you are sleeping or even having a someone come in turning a key on your face, no wonder you couldn’t stand using it. That’s not how a sleep study is supposed to be done. It’s supposed to be done slowly over time with you using the device first for a while so you know how far it can work out for you. Do you mind me asking who this dentist is? Because all the sleep dentist in Pittsburgh pa make me pay out front to use it and there’s no trail period after the custom device is made up. What mouthpiece did you use? Wish my sleep dentist would offer me that option of free trials. Something doesn’t make sense in how you said you got the mouthpiece for free and only had to pay if it’s proven to work. Did they give you any time to use it until it was comfortable like a few months etc or did they just throw you right into a sleep study right away. The standard for a follow up is about a yr later with the mouthpiece and you are supposed to follow up with your sleep dentist every few months to see how your progress is doing before you take the sleep study.

I glad you can do what works for you but it’s not medically proven that boil and bits work for sleep apnea. They aren’t the same thing as MADs that are approved, so you could be having a placebo effect with it...

[D.H.]

I had a "fatty liver" prior to CPAP. I also had an excessive number of red blood cells. Both levels returned to normal once I started CPAP and have stayed there for over nineteen years.

[dogsarelife]

Has anyone ever had any experience of linking abnormal liver function blood test results to untreated osa? Over the last 6-7 years (and around the time I was diagnosed with osa) my doctors noticed I had unexplained elevated liver ast/ast. It would go up and then back to normal with months and months of testing over the years. After seeing a liver specialist doctor having multiple blood tests, a liver biopsy and fibroscan and there’s nothing wrong with my liver, maybe some fatty liver and something that the doctor can’t explain to maybe very tiny external damage that is benign in all the scans. My doctors have no idea what’s going on but there’s nothing major/scarring etc.

Hi @Ravenous28

So first, the anecdotal experience, for what it's worth - I had abnormal liver enzymes. My PCP at the time ran all sorts of tests that I had a feeling would not find anything, and nothing was really found - my liver function was normal, no autoimmune diseases or clotting issues, and I forget what else they tested. It was just marked down as an anomaly on my chart. however, when I had blood work done after less than a year on apap, my liver enzymes were still a smidge elevated, but worlds better than pre-xpap.

That surprised me, but there are others who had a similar experience, per the below study that I found.

(note: you have to be careful with studies and really look into if the methodology they use is quality, if the sample size is large enough (you can show a huge effect of almost anything if you have a small number of people, for example), if the researchers accounted for confounding factors, etc. However this sample size was fairly large, and does show an effect of xpap on NAFLD.)


https://www.ncbi.nlm.nih.gov/pubmed/30092894
"Continuous Positive Airway Pressure Therapy on Nonalcoholic Fatty Liver Disease in Patients With Obstructive Sleep Apnea."

RESULTS:
Of 351 patients with OSA on CPAP treatment, majority (mean age 57.6 years, 59.3% male) had abnormal ALT, and 89.4% met the criteria for sNAFLD. The prevalence of sNAFLD was higher among patients with moderate to severe OSA (90.6%) versus mild OSA (86.3%). There was a statistically significant improvement in AST, ALT, and APRI with CPAP therapy (all P < .01). There was an apparent dose-response relationship: patients with good adherence to CPAP showed a significantly larger decrease in AST and ALT than did those with poor adherence (P < .01). Multivariable logistic regression analysis showed CPAP treatment with adequate adherence (odds ratio = 3.93, 95% confidence interval = 1.29-11.94) was an independent predictor of regression of sNAFLD after adjusting for obesity class and severity of OSA.

CONCLUSIONS:
OSA treatment with CPAP was associated with significant biochemical improvement and reduction in NAFLD-related fibrosis.

There are some case studies of a male or two who completely reversed NAFLD with xpap that I thought about posting, but as case studies are generally sample size of 1, who knows exactly what is going on there. But I think those case studies showed decrease in liver enzymes and reversal of fatty liver disease over the course of several years.

And I didn't search pubmed for fatty liver, sleep apnea and oral appliances, but maybe there have been some papers published and I just couldn't find them. Researchers aren't exactly sure what causes fatty liver, but some doctors speculate it is hypoxia that causes the fatty liver, so I suppose I might try monitoring my oxygen levels overnight were I to be inclined toward an oral appliance? But there are of course no guarantees that maintaining normal oxygen levels during sleep has the same result as using cpap. I know there are a lot of things about sleep I have yet to understand.

I hope my anecdotal story and the study I posted helped, that you can find a monitoring solution that works for you and helps you sleep well, and that you can find a solution that helps you feel comfortable that sleep apnea is not contributing to your liver issues.

[ravenous28]

Thank you so much for this.. I’ll have to see what my liver doctor says about it next time I see him in August. The problem with it is getting a doctor to agree it’s a factor or not. I won’t know regardless unless I treat the apnea properly and keep pulling blood labs..

[dogsarelife]

I would bring the research papers, if I were you. My pcp unfortunately did not make the connection. I had to realize that sleep apnea could be causing my body to go bananas.

When my liver enzymes and red blood cells started to rise again last year, I knew that something was off with my sleep treatment, and my first sleep doctor ignored it, but luckily my second sleep doctor did take it seriously (he's aware of the connection between sleep apnea and how it affects all the systems of the body), got me in for a titration, and put me on bilevel-pap.

So I sort of see my blood work going awry as a sign for if my sleep treatment is going ok? But everyone is so individual, and your mileage with this may vary.