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

ChicagoGranny wrote:

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

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.

Thanks ChicagoGranny for your post. I don't know if it was the result of 9 months of complete CPAP adherence or not, but on Friday I had my routine appointment with my cardiologist. Sleepyhead and odometer reports really impressed him. In addition, maybe no correlation, but my labs and Echo came back with improved results. So, I am not going to read these studies any more and go to the gym and do the treadmill like I do 3 times a week.

RobertS975 wrote:

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.

With regards to obesity, this is borne out in a recent study (2014) published in the New England Journal of Medicine.

"As reported in previous studies, weight loss significantly reduced CRP levels, insulin resistance, dyslipidemia, and blood pressure. In contrast, CPAP therapy did not have a significant effect on CRP level, insulin sensitivity, or dyslipidemia, even among participants who adhered to the therapy. Cross-sectional observational studies and prospective observational studies have yielded conflicting results regarding the role of obstructive sleep apnea in inflammation, but the two largest observational studies did not show a reduction in CRP levels after 9 to 12 months of CPAP therapy in patients with obstructive sleep apnea."

http://www.nejm.org/doi/full/10.1056/NE ... #t=article

49er wrote:"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.

I'm shocked by the statement of 3.3 hours CPAP usage per night. That can't be right, can it? Has anybody else seen this supposed statistic before

I have read a book about map making titled "How To Lie With Maps".
There could (or may be) a similar book about lying with "studies".
Everyone should be aware of junk science and how to identify it.

I want to point out this particular item:

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

I can say from personal experience that it is as though I didn't use CPAP at all if I don't have the cpap on between 3 and 6 a.m., the time period when I get the most REM according to my two studies (and as indicated by my pressure changes). Whether this is true for others, I don't know. That is why it was such a problem for me when I kept pulling my mask off at night. It was always BEFORE that 3 a.m. marker.

Sir NoddinOff wrote:

49er wrote:"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.

I'm shocked by the statement of 3.3 hours CPAP usage per night. That can't be right, can it? Has anybody else seen this supposed statistic before

SNO,

A few years ago when I was trying to decide about having a septoplasty, the surgeon wasn't concerned about doing my procedure as an outpatient as long as I was using the machine at least 3 hours a day. So somewhere, that statistic is out there even though it may be be total BS.

49er

Greendirt wrote: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.

Junk News for fools, Question, how do you measure heart attack, strokes, that never happen. Jim

SewTired wrote:I want to point out this particular item:

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

I can say from personal experience that it is as though I didn't use CPAP at all if I don't have the cpap on between 3 and 6 a.m., the time period when I get the most REM .....

Same here, SewTired.

chunkyfrog wrote:I have read a book about map making titled "How To Lie With Maps".
There could (or may be) a similar book about lying with "studies".
Everyone should be aware of junk science and how to identify it.

It's called How to Lie with Statistics, originally published in the 50s.

https://www.amazon.com/How-Lie-Statisti ... statistics

Almost all PAP studies are similarly flawed. Few study 100% adherent users with low leak and optimized pressures. Which makes almost all medical statistics about PAP completely meaningless and utterly misleading.

In the context of OSA, all that effective PAP will do for you is to allow you to breathe and to sleep. Does breathing prevent heart attacks? Does sleeping prevent heart attacks? Either way, they are both absolutely basic to life, and destroying either one will kill you one way or another.

Studies are nice when done by people with a common-sense basic understanding of what they are studying. But that sort of thing is becoming quite rare, IMO.

I have a friend who after a quad by-pass denied untreated sleep apnea was a factor saying the heart disease runs in his family. Telling him that so does OSA was a waste of breath.

I also think that untreated OSA is a contributing factor in alzheimer's, poor decision making, mood swings, and chronic fatigue .

And simply wearing a mask does not equal treatment. The cpap has to be adjusted so that it eliminates events or you are wasting your time and money.

So now we know why ASAA recommends a min. of 4 hrs daily use. Maybe someone should study effective cpap use at 7 or 8 hrs as compared to 4 to 5 hrs of daily use. By effective I mean an AHI <2.

Just co-signing the sentiment of those who find this study a total waste of time. Would be like a diabetes study looking for positive health outcomes when those studied kept their sugar level in the recommended range less than half the time on an average. When a study is so obviously weighted to lose, I have to wonder why they even bothered. Either they just wanted a paycheck, or it's a set-up for acceptance of a cpap alternative. Hey, how about a study comparing CPAP users who use their treatment 100% of the time vs those part time users. Now that's some results I'd be interested in seeing. For the life of me I can't imagine a physician knowing a patient is diagnosed with OSA and putting them in a control group without treatment. Yikes! BTW, what is the definition of the "usual" care received?

delete

Avi - do you seriously think a research physician who likely publishes articles routinely would not know about copyright laws?