compression stockings reduce apneas & hypopneas by 30-36%

[johnthomasmacdonald]

Seems the fluid pooling in the legs during the day gets back into circulation when lying horizontal increasing neck circumferance and thus obstructive sleep apnea - one study saw a reduction of 30%, the other by 36%. While not a cure, it might allow you to drop the cpap pressure significantly , making it more comfortable. Even if you don't think you have this problem, it might be worth just buying a pair of compression stockings and give a try for yourself. Following are 2 abstracts from 2 different groups.



1)Am J Respir Crit Care Med. 2011 Nov 1;184(9):1062-6.

Attenuation of obstructive sleep apnea by compression stockings in subjects with venous insufficiency.

RATIONALE:
Fluid accumulation in the legs and its overnight redistribution into the neck appears to play a causative role in obstructive sleep apnea (OSA) in sedentary men. Chronic venous insufficiency (CVI) promotes fluid accumulation in the legs that can be counteracted by compression stockings.

OBJECTIVES:
To test the hypotheses that, in nonobese subjects with CVI and OSA, wearing compression stockings during the day will attenuate OSA by reducing the amount of fluid displaced into the neck overnight.

METHODS:
Nonobese subjects with CVI and OSA were randomly assigned to 1 week of wearing compression stockings or to a 1-week control period without compression stockings, after which they crossed over to the other arm. Polysomnography and measurement of overnight changes in leg fluid volume and neck circumference were performed at baseline and at the end of compression stockings and control periods.

MEASUREMENTS AND MAIN RESULTS:
Twelve subjects participated. Compared with the end of the control period, at the end of the compression stockings period there was a 62% reduction in the overnight leg fluid volume change (P = 0.001) and a 60% reduction in the overnight neck circumference increase (P = 0.001) in association with a 36% reduction in the number of apneas and hypopneas per hour of sleep (from 48.4 ± 26.9 to 31.3 ± 20.2, P = 0.002).

CONCLUSIONS:
Redistribution of fluid from the legs into the neck at night contributes to the pathogenesis of OSA in subjects with CVI. Prevention of fluid accumulation in the legs during the day, and its nocturnal displacement into the neck, attenuates OSA in such subjects.


2)Respir Physiol Neurobiol. 2011 Mar 15;175(3):390-3. Epub 2011 Jan 8.

Effects of venous compression of the legs on overnight rostral fluid shift and obstructive sleep apnea.

Abstract
The amount of fluid displaced overnight from the legs into the neck as a consequence of lying recumbent correlates with the number of apneas and hypopneas per hour of sleep (AHI). Sedentary living promotes dependent fluid accumulation in the legs that can be counteracted by venous compression of the legs (compression stockings). We hypothesized that, in non-obese sedentary men with obstructive sleep apnea (OSA), wearing compression stockings during daytime will reduce the AHI by reducing the amount of fluid available for the displacement into the neck overnight. Polysomnography and measurement of overnight changes in leg fluid volume and neck circumference were performed at baseline and after one day of legs venous compression. The median AHI decreased from 30.9 (interquartile range 19.6-60.4) to 23.4 (12.9-31. (P=0.016) in association with a median 40% reduction in the change in leg fluid volume (P=0.016) and a median 42% reduction in the increase in neck circumference (P=0.016). These results provide proof-of-principle that overnight fluid displacement into the neck plays a causative role in OSA.

[Addercatter]

Wow, that's very interesting! I love these sort of studies, as
I once worked for a clinical research company. Migh have to grab up some
Compression stockings for myself

[mayondair]

There were some threads about this last year if i remember it was a small test group with chronic venous insuffiency, and they were talking about thigh high 30-40 mg compression stockings. I had laser ablation for varicose veins last year, wore said stockings for a while when recovering, I used an APAP at the time, I never saw a difference before or after surgery. I wear 20-30 knee highs now when I'm working and will be on my feet, they sure make my legs feel better after a long day, but no OSA benefit. Kathy

[SleepingUgly]

When I saw the title of this thread, I thought the stockings would be for the neck. I think that would work better.

[BlackSpinner]

When I saw the title of this thread, I thought the stockings would be for the neck. I think that would work better.

Same here. Or they could be used to keep the nasal pillows of the hybrid in place!

[Todzo]

Seems the fluid pooling in the legs during the day gets back into circulation when lying horizontal increasing neck circumferance and thus obstructive sleep apnea - one study saw a reduction of 30%, the other by 36%. While not a cure, it might allow you to drop the cpap pressure significantly , making it more comfortable. Even if you don't think you have this problem, it might be worth just buying a pair of compression stockings and give a try for yourself.

Hi johnthomasmacdonald,

To prevent Rostral Fluid Shift I raise the head of my bed. I would love to see studies on the effects of raising the head of one's bed regarding this and OSA in general.

Thanks for the paper - first time I noticed the Chronic venous insufficiency (CVI) connection.

Bet this relates to CO2 maintence!

Have a great week!

Todzo

[archangle]

First, it's important to note the limited scope of the study. The study was for people with CVI (Chronic Venous Insufficiency) and apnea, not just any CPAP patient. It was also for non-obese patients.

That's not as crazy as it might seem at first. Swelling of the legs can cause a large change to the legs. If the swelling "migrates" to the throat and airway tissues when you sleep, I could see changes in the neck that make changes in apnea.

I wonder if there might not be some other fluid management techniques that could help in apnea management. Maybe something like drinking a lot of water at certain parts of the day, taking diuretics at certain times of the day, etc.

If nothing else, it adds an additional reason to not ignore swelling of the legs. It indicates some potential other medical problems and may cause some problems in and of itself. It's not simply fat or a water retention.