Do CPAPS decrease cardiovascular events?

[bearinthefield]

Doing some research recently, I came across an article in Thorax, the International Journal of Respiratory Medicine (2006) that said there are no large, controlled trials which have examined the impact of CPAPs on strokes and heart attacks. They stated the evidence that suggests it is beneficial is all circumstantial, especially for mild or moderate cases. It says that CPAPS have not been shown to impact c reactive proteins. (bad stuff I guess).

Any one know if there are any newer trials which clearly establishe that cpap use decreases strokes or heart attacks? If there are no such studies, any guess why this has not been studied after all these years, given the large number of folks who have OSD?

[Breathe Jimbo]

See the following 2010 article:

http://www.ncbi.nlm.nih.gov/pmc/article ... ool=pubmed

Sleep-disordered breathing and cardiovascular disorders.
Budhiraja R, Budhiraja P, Quan SF.

Source
Division of Sleep Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, MA 02215, USA.

Abstract
Compelling data demonstrate a strong association between sleep-disordered breathing (SDB) and cardiovascular disorders. The association is most consistent between obstructive sleep apnea (OSA) and hypertension. Epidemiologic and clinic-based studies provide evidence for an etiological role of OSA in hypertension, independent of obesity. Furthermore, several studies suggest amelioration of hypertension with therapy for sleep apnea. Emerging data also suggest a role for OSA in causing coronary artery disease. This association is bolstered by evidence suggesting that continuous positive airway pressure (CPAP) therapy improves early signs of atherosclerosis and may impede progression to clinically important cardiovascular disease. SDB (both OSA and central sleep apnea) is frequently observed in patients with heart failure. OSA may be a risk factor for incident heart failure. The current data do not provide consistent evidence for whether treatment of SDB will improve survival or other end points in patients with heart failure, and larger trials are currently underway to better elucidate that relationship. Substantial evidence also links SDB to an increased risk of various arrhythmias. Treatment of SDB with CPAP appears to significantly attenuate that risk. Finally, several studies suggest SDB as a risk factor for stroke. Whether treatment of SDB reduces stroke risk, however, remains to be determined. In conclusion, persuasive data provide evidence for an association, probably causal, between sleep-disordered breathing and several cardiovascular disorders. Large randomized controlled trials will further help confirm the association and elucidate the cardiovascular benefits of SDB therapy.

[Wulfman...]

Doing some research recently, I came across an article in Thorax, the International Journal of Respiratory Medicine (2006) that said there are no large, controlled trials which have examined the impact of CPAPs on strokes and heart attacks. They stated the evidence that suggests it is beneficial is all circumstantial, especially for mild or moderate cases. It says that CPAPS have not been shown to impact c reactive proteins. (bad stuff I guess).

Any one know if there are any newer trials which clearly establishe that cpap use decreases strokes or heart attacks? If there are no such studies, any guess why this has not been studied after all these years, given the large number of folks who have OSD?

How long would they have to "study" it? And, how large of a study would it have to be?
Sounds like those types of studies would be pretty darned expensive to me.
For one thing, the patients' therapy would have to be extensively monitored for the effectiveness. How would they monitor that? More sleep studies? We KNOW that the medical community doesn't believe that the data from these machines is credible. Would they just "wait" until any of the participants had any strokes or heart attacks?

For all intents and purposes, CPAP/APAP/Bi-Level therapy generally adds more oxygen to the users' systems. I don't think anybody can argue that there's anything wrong with that.


Den

[jimnsc]

I'd just like to add that my Cardiologist ordered my sleep study. She stated Cardiologists in general now strongly believe that sleep apnea 'may' be a leading contributor toward the disorder I've experienced three times - Atrial Fibrillation. I have been cardioverted back to normal sinus rhythm each time by electrical stimulation. Now that I am getting my OSA under reasonable control - we'll see, I guess. All doctors in this practice of 13 Cardiologists have made it standard procedure to order a sleep study for each A. Fib. patient they treat. Being one of the first treated with OSA I am a part of a study this group of doctors has underway.

[Breathe Jimbo]

wulf, I don't think anyone is trying to prove that xPAP is bad. Rather, I think the issue is proving, WITH THE SCIENTIFIC METHOD, that xPAP ameliorates the cardiac risk factors that accompany untreated obstructive sleep apnea and other sleep-disordered breathing. If that can be shown WITH THE SCIENTIFIC METHOD, that would lead to a much bigger push, with a lot more money behind it, to have untreated OSA and SDB diagnosed and treated.

[Bons]

I can speak to my own experience. I have a 20-year history of PVC's. Started cpap/bipap/asv in August of last year. Last week I had a stress test with echocardiogram, and had no PVC's at all while walking the treadmill or during the before and after echos.