Heart Disease, CPAP better than APAP: one study

[longsufferingwife]

While researching, I found this article too, stating that CPAP and APAP do not both work effectively on heart patients (my husband has Coronory Artery Disease also.) I assume a Respironics BiPAP auto M series (set on certain pressures, now 14/10 --- is not in its auto, APAP mode? Correct?
Is anyone able to access the entire article below?



Fixed and autoadjusting continuous positive airway pressure treatments are not similar in reducing cardiovascular risk factors in patients with obstructive sleep apnea.Patruno V, Aiolfi S, Costantino G, Murgia R, Selmi C, Malliani A, Montano N.
Department of Respiratory Rehabilitation, S. Marta Hospital, Rivoli d'Adda, Ospedale Maggiore, Crema, Italy.

BACKGROUND: A strong association between obstructive sleep apnea (OSA) and the risk for cardiovascular and cerebrovascular diseases has been reported. Continuous positive airway pressure (CPAP) is the first-line therapy for OSA, able not only to reduce daytime sleepiness but also to improve cardiovascular and metabolic outcomes. Autoadjusting CPAP (APAP), an alternative treatment to CPAP, can reduce OSA symptoms while increasing long-term CPAP compliance without the high costs of CPAP titration. However, no data are available on the effects of APAP on cardiovascular risk factors METHODS: We performed standard full polysomnography; obtained plasma levels of glucose, insulin, and C-reactive protein (CRP); and measured systolic BP (SBP) and diastolic BP (DBP) in 31 patients with newly diagnosed, severe OSA. After standard CPAP titration, all subjects were randomized to CPAP or APAP treatment. Measurements were obtained at baseline and after 3 months of treatment. RESULTS: The two groups were similar in terms of age, sex, body mass index (BMI), and severity of OSA. SBP, DBP, heart rate (HR), homeostasis model assessment index (HOMA-IR), and CRP were similar in the two groups. After 3 months of treatment, BMI, HR, and compliance to therapy were also comparable. OSA indexes were significantly reduced in both groups. Significant reductions in SBP, DBP, and HOMA-IR were observed in the CPAP group but not in the APAP group, while CRP plasma levels were similarly reduced. CONCLUSIONS: Our results suggest that CPAP and APAP, despite significant effects on OSA indexes and symptoms, do not improve cardiovascular risk factors in the same fashion.

[Sleeprider]

While researching, I found this article too, stating that CPAP and APAP do not both work effectively on heart patients (my husband has Coronory Artery Disease also.) I assume a Respironics BiPAP auto M series (set on certain pressures, now 14/10 --- is not in its auto, APAP mode? Correct?
Is anyone able to access the entire article below?

Interesting summary. I hope more work is done in this area in the future to confirm the study. Since the study did not evaluate BiPAP therapy, and for that matter, exhalation relief like Cflex or Aflex, I don't know that you can extrapolate the results to those technologies. The summary lacks quantitative discussion of the differences and parameters of significance for making the determinations. Certainly worth a follow-up though.

[cwsanfor]

This is an interesting result. I hope the resident gurus address the implications.

Does the link http://www.chestjournal.org/cgi/content/full/131/5/1393 resolve for you without authentication?

[Snoredog]

this has been posted several times before, you can make a study say just about anything you want it to.

The study is a bit confusing when it states "while CRP plasma levels were similarly reduced".

A C-reactive protein (CRP) test is a blood test that measures the amount of a protein called C-reactive protein in your blood. C-reactive protein measures general levels of inflammation in your body. Hypoxia from untreated OSA can lead to higher levels of inflammation which triggers the whole CVD process. Eliminate the inflammation by keeping oxygen levels up and the factors that lead to CVD are reduced.

Sorry but that study is kinda worthless counter productive if you understand the root causes of CVD. That is like comparing jumping jacks to push ups for effectiveness of exercise.

Understand this: No medical professional in the sleep industry is going to recommend auto CPAP if they have a financial interest in it, doing so they are shooting themselves in the head or in this case the pocketbook. With an autopap you don't need to have your hand held by the doctor every 3 months or visit the sleep lab and DME as often, so any employee involved in any aspect of that treatment is going to bad mouth autopaps when ever and where ever they can. Yet these individuals are the very reason Auto CPAP gets a bad rap, they have NO idea how to set one up other than sending it out with the patient with "Default" settings of 4cm to 20 cm. Many times they send machines set this way because they know they will fail just so they can tell the patient they told them so.

IF they were even half as bad as sleep medicine makes them out to be why do they make and sell so many? Remember the recall by Resmed a few years ago on the S8, they sold like 300,000 of them in a 12 month period.

Ask anyone that knows better that has been on this therapy long term and they will take the Auto CPAP every time.

[DreamStalker]

The actual study admits that the APAPs were set wide open starting at 4 cm

The idiots just don't know how to use an APAP to be doing these kinds of studies

[Goofproof]

Due to the many ways each type of machine can be set up, and the differing needs of each patient, I would say that drawing a firm conclusion, would be in the direction of which way they wanted the data to point. Every one has a a point to make about what works best, that doesn't always lead to truth or a correct mind set. Get a data recording machine and the software, and keep tabs on your own treatment, make changes based on how your treatment works best for you. Jim

When I find out something for myself, I don't have to worry how it applies the the masses, or how the test was aimed.

[Captain_Midnight]

Dream Stalker writes...

The actual study admits that the APAPs were set wide open starting at 4 cm

The idiots just don't know how to use an APAP to be doing these kinds of studies

D.S. you are quite correct.

From Table 2 in the full paper...

.............APAP.........CPAP
AHI, /h....6 ± 2.3....... 2 ± 1.6
ODI, /h....4.8 ± 2.1......1.1 ± 1.3

I read this paper last year and concluded that the study could have ended right there.

Anyone needing evidence to set the lower pressure of the APAP range at or near the titration pressure might want to look at the paper, or at least the abstract.




.

[deerslayer]

yep, my apap when set by the powers that be had ranges IMHO that were set too wide..... from daily stats my study indicates that by tweeking upward of min settings has improved my overall health , therapy & compliance plus decreased frequency & number of events. these findings will most likely result in a switch being cut when i present this report to those powers that be. moreover, this non-event will have a minimal affect to future studies or homeostatic mechanism .

[Wulfman]

The actual study admits that the APAPs were set wide open starting at 4 cm

The idiots just don't know how to use an APAP to be doing these kinds of studies

That's basically what I told those dumb asses the last time they published a study comparing the effectiveness of CPAPs and APAPs.

http://www.chestjournal.org/cgi/eletters/131/5/1393

They don't have a clue......they're "DOCTORS" (or at least they've got a bunch of letters behind their names) and they spend/waste grant money to do this kind of nonsense.

IDIOTS!

Den

PS......If you want to make a point about their lack of knowledge about APAPs, post a response to their study.

[Snoredog]

The actual study admits that the APAPs were set wide open starting at 4 cm

The idiots just don't know how to use an APAP to be doing these kinds of studies

Yep that doesn't surprise me. Ever notice the starting pressure with a PSG titration? Even they don't start a patient off at 4 cm, every PSG I have ever had done started off at 5 cm pressure at a Minimum. So why do they send these machines out for a patient set even lower at 4 cm to 20 cm? Ah that's right, Doctors orders, seeing this tells you what doctors know about these machines and therapy. Makes you wonder when they go to prescribe a drug, do they even know what that drug does before they prescribe it?

[dsjm1]

Am in full agreement with the comments regarding testing APAPs where min pressure is left to the lowest setting.

That is a truly dumb aspect of issuing apaps through organizations who don't understand the use of the machines but to be fair, they are largely guided by the info fed to them by the manufacturers.

And, I am sure that will continue.

DSM

PS I like the new anti spam set up. That spam was getting quite out of control. Good work !

[dsm]

Above post shd have read - dsm as the poster. Fingers were quicker than my sleepy brain.

DSM

[mindy]

I read the entire paper awhile back and agree with a lot of the comments here. Also, it was a fairly small study and it didn't seem to me to be sufficient data to extrapolate from. However, many medical studies do start this way and then expand to larger studies with more "power" to detect real differences. Correlation does not, however, equal causality.

In any case, since APAP's can also be set in CPAP mode, I still think that an APAP is a better choice than a CPAP (unless of course one needs a BIPAP or VPAP!). I use mine in straight CPAP mode but do occasionally switch to auto to see what happens (my own little home titration).

Mindy

[Guest]

the sleep docs just want the sleep apnea suffers to sleep on the train at one speed and funnel the $ to their pockets...instead of smart auto-cruise that make no $ for them. go figure out.....the docs are just a advisors......the actual machine is the one doing the job!

Mckooi

[bigk]

Interesting comments.

The Resmed clinic I attended only offered me the APAP - CPAP was never even offered as an option but then I guess our insurance system operates differently here than in the USA. I only got roughly half of my purchase price back - so I guess it was essentially an out-of-pocket expense and by selling me the APAP they got more money - but now with what I have learnt here it is the machine I would have purchased anyway so no harm done.

Also interesting is that when I purchased the Resmed - (not from the clinic as their prices were a joke) the online DME left it at the standard 4-20. The Resmed one I did my trial on was set to 6-15 so I set the one I purchased to that.

Then as I learnt more, I increased my minimum from 6cm (where I could hardly breathe) to 9cm and then 10cm. The result of that was to DECREASE the maximum pressure I had been getting up to overnight. Now I rarely go over 12cm whereas with the minimum at 6 I was hitting the 15 maximum.

Some doctors really are clueless.