CPAP increases blood pressure?

[noeldoku]

Hi,

Does anyone have any experience of CPAP increasing blood pressure?

My mother was recently diagnosed with severe OSA after 2 hospitalisations for AF, tacycardia and a suspected cardiac event. She is in her late 60s and has been hypertensive for over 20 years.

After two weeks of CPAP her blood pressure has actually increased (2 of her 4 largest diastolic and 3 of 7 largest systolic readings have occurred whist on CPAP) and her daytime sleepiness has not improved. Her heart rate is now consistently lower than her historical average. Her snoring hasn't stopped completely, but is much improved. As far as I can tell she is compliant and the mask is well fitted.

I am worried this is an abnormal initial response.

I did contact the specialist, who seemed unconcerned, but didn't present an explanation. I can't find anything about it on-line. (FYI I did find a nice letter which mentions negative initial responses to CPAP here http://www.aasmnet.org/jcsm/Articles/020405.pdf)

Could it be possible that reversal of cardiac remodelling could increase stroke volume with a consequent (temporary) increase in blood pressure?

Any suggestions or links would be very welcome. Details of her BP and heart rate are included below.

Thanks in advance
Noel

[old64mb]

In a word, no, if it's being treated properly.

The JCSM article you provided deals with what can happen if you attempt to treat a patient who suffers from predominantly central sleep apnea by using a machine that doesn't treat that particular disorder. When it was written back in 2006, there were no xPAP treatments for CSA as Resmed had just come up with the servoventilator concept. 7 years later, that's definitely not the case.

My suggestion would be to start out by checking your mom's AHI. If there are a bunch of untreated apneas remaining, then it's time to see if the treatment needs to be tweaked. It could very well be that she has a CSA variant, or it could be that it's just OSA that's not being treated effectively for a variety of reasons. We can help you with suggestions on how to approach medical professionals with both of those.

One thing to keep in mind on blood pressure too: it has its own circadian rhythm, so xPAP or not, if someone is napping during the day their BP is going to be higher than at night.

[chunkyfrog]

Since she has only been a "hoser" for 2 weeks, I wonder how she is adapting to treatment.
Mask fit: does she complain about discomfort (or do you see high leak levels?)
Both can disrupt sleep.
Does she have any anxiety about being "on a machine", (or depression)
Getting everything to work properly while making the patient comfortable and trusting the equipment is key
Good luck with your mother. She is very lucky to have you there.

[BlackSpinner]

Her snoring hasn't stopped completely, but is much improved. As far as I can tell she is compliant and the mask is well fitted.

If she is still snoring she is probably not at the correct, most effective pressure.
You really need to download the data from the machine - assuming they didn't give her a crappy brick.

At 2 weeks she will still be dealing with "sleep debt" of some sort too.

[DiverCTHunter]

Her snoring hasn't stopped completely, but is much improved. As far as I can tell she is compliant and the mask is well fitted.

If she is still snoring she is probably not at the correct, most effective pressure.
You really need to download the data from the machine - assuming they didn't give her a crappy brick.

At 2 weeks she will still be dealing with "sleep debt" of some sort too.

Agreed. She's still in the 30 day window, so even if it is a brick, there's still time to get a DAW scrip for a full data machine.

[noeldoku]

Thanks so much for all your advice!

I'm guessing (total newbie - sorry) a follow-up sleep study is standard procedure. If one hasn't been scheduled I'll push for one, but it's always tricky dealing with health professionals - being proactive is often seen as meddling.

If she is still snoring she is probably not at the correct, most effective pressure.
You really need to download the data from the machine - assuming they didn't give her a crappy brick.

At 2 weeks she will still be dealing with "sleep debt" of some sort too.

She's on a resMed S9 which I believe has a recording device and memory card. Is there an easy way for me to access this data, and if I did would it tell if the pressure too low?

Thanks again!

[kteague]

What studies has your mother already had in the sleep lab - one for diagnosing and one for titration? It could be helpful if you had copies of those as sometimes there are clues in them. As far as a repeat study, my thought on that it's a bit too soon to tell if it is needed. I support what others have said about Step #1 is to determine if her current settings are indeed therapeutic. That can be done at home. That information will lead you to the natural next step. If you reach the point where her data confirms effective treatment and she still is not improving over time, then another sleep study might be suggested. While sorting through all this, it might be a good time to research any meds she is on and see if any can cause side effects that is experiencing, and if so, talk to her doctor about it. It's good your mother has you to help her through this. Being a caregiver is tough. Quite a few on this board have talked about the difficulty of that role. Hang in there.

[SethW]

She's on a resMed S9 which I believe has a recording device and memory card. Is there an easy way for me to access this data, and if I did would it tell if the pressure too low?

That depends on how you define "easy." I can never remember for sure, but according to my profile, I have an S9 Elite. My SD card is in a slot in the upper right corner of the machine as you look at it from the back. It works like any other SD card. There is software called SleepyHead that you can download to read the data. If your mother is not compliant it will totally rat her out on that. Data might reveal something else useful or worth talking to somebody about.

I don't know if my BP went up but I have gained weight. Oops! But if using CPAP has knocked out your mother's AF, then that is a big win in my book.

[-tim]

A change in heart rate can result in a change in blood pressure. If the heart rate is high, and he blood pressure isn't too high, then a slower heart rate with a slightly higher pressure might be better for the heart.

The blood pressure does go up while on the machine. The increased pressure goes into the lungs and is transferred to the blood. xPAP treatment seems to increase artery elasticity which is a good thing but that also may make pressure changes more variable. There is a doctor at St Vincent's in Melbourne Australia who has been looking at that connection.

What you have said implies that the xPAP pressure isn't right but it takes time to get used to the machine. If there are insurance issues, then compliance is essential and it may be better to get past the 30 days (or whatever) and then look at adjusting the pressure for more effective treatment.

If you have the data, you can post it here and people will let you if they see anything unusual.

[jnk]

-SWS sure does have a way with words when it comes to such matters. And his words from 2004 still make a lot of sense to me in 2013:

http://www.talkaboutsleep.com/message-b ... php?t=3264

[70sSanO]

I can tell you that my doctor discovered my sleep apnea from my blood pressure taken at different times throughout the day. It seems that before CPAP my blood pressure was the highest in the morning after I woke up when I would have been rested, it would actually drop throughout the day. So he ordered a sleep test and here I am.

I will say that CPAP did not eliminate my hypertension as I still take a medication for it. I'm not sure if the damage was done and CPAP merely prevented it from getting worse or killing me along the way.

John

[archangle]

She's on a resMed S9 which I believe has a recording device and memory card. Is there an easy way for me to access this data, and if I did would it tell if the pressure too low?

"S9" doesn't tell us enough info to tell you anything. Look next to the power button for something like Escape, Elite, AutoSet, etc.

[noeldoku]

-SWS sure does have a way with words when it comes to such matters. And his words from 2004 still make a lot of sense to me in 2013:

http://www.talkaboutsleep.com/message-b ... php?t=3264

Thanks for the link. Sleep deprivation could well explain it, since she hasn't really had time to get used to her treatment and she is still sleepy during the day. I guess if that is the case then she should improve over the next few weeks before her next hospital appointment, if not then it could be a pressure issue I suppose.

Not sure how to upload the data/jpeg image. The Img button just gives me tags: if I drag and drop the filename appears, but previewing gives only the filename and not the image file.

here is a doctor at St Vincent's in Melbourne Australia who has been looking at that connection.

Do you have the doctor's name?

[BlackSpinner]

Not sure how to upload the data/jpeg image. The Img button just gives me tags: if I drag and drop the filename appears, but previewing gives only the filename and not the image file.

First sign up with a photo storing site like Flicker or photobucket. On Filckr click on the image then on the share button, then chose the Html/bbcode option, then click on BBCcode choice, copy what you get and just paste it right on the page. This is because this site doesn't host the pictures, it takes too much room.

[noeldoku]

First sign up with a photo storing site like Flicker or photobucket. On Filckr click on the image then on the share button, then chose the Html/bbcode option, then click on BBCcode choice, copy what you get and just paste it right on the page. This is because this site doesn't host the pictures, it takes too much room.

Ah, great - thank you!

Here is a time series of my mother's readings:

BP_HR_timeSeries by noeldoku, on Flickr

It seems to me that her BP readings were trending up since November (before CPAP), which might suggest an issue with her medication (which changed mid last year due to her AF/cardiac event) or (guess) a response to 2 AF events she had in this period. I did buy her an anti-snore pillow around this time since we were still waiting for her sleep study results, so it is possible (although I concede extremely unlikely) that this could be a continuation of her negative blood pressure response to sleep therapy treatment.

What was alarming and confusing for me is not just that CPAP didn't seem to lower it, but that the frequency of extreme high numbers appears to have increased. The histograms below show the post-CPAP BP data in blue, against the whole data set (red):


diastolic by noeldoku, on Flickr


systolic by noeldoku, on Flickr

One thing I forgot to mention before was that she is not waking up so often at night to go to the toilet: only twice rather than 3 or 4 times. I'm guessing this suggests a deeper sleep and/or less sympathetic activity, but this isn't consistent with her ongoing daytime sleepiness (unless as someone suggested she may be paying off a sleep debt).