Effect of CPAP Therapy on Cardiovascular Events and Mortalit

[Julie]

From Medscape today -

Effect of CPAP Therapy on Cardiovascular Events and Mortality in Patients With Obstructive Sleep Apnea: A Meta-analysis

Guo J, Sun Y, Xue LJ, et al
Sleep Breath. 2016 Feb 12. [Epub ahead of print]

Serious cardiovascular outcomes, including mortality, are associated with obstructive sleep-disordered breathing. Given that obstructive sleep apnea (OSA) is quite common in both men and women aged 50 years or older, it remains important to determine whether treatment of OSA might improve cardiac outcomes of patients who also have cardiovascular disorders. Previous studies have not provided a clear answer, largely because they were underpowered.[1]

The current study was a meta-analysis of 18 large, prospective, randomized, controlled studies with a total of 4146 patients. The included studies had "cardiovascular," "mortality," or "blood pressure" in their titles and comparing outcomes of patients given continuous positive airway pressure (CPAP) with those in patients who received sham therapy or with untreated control participants. The mean age was 63.4 years, and 75% of participants were male. Smokers and patients with type 2 diabetes were included.

The mean duration of CPAP administration was 5 hours per night, and the mean duration of follow-up was 30.5 months. The Epworth Sleepiness Scale was reduced in the CPAP group by -1.78 units (P < .001), suggesting that CPAP had been performed.

The risk for cardiovascular events of any type was slightly reduced in the CPAP group vs control (odds ratio, 0.84), but statistical significance was not reached (P = .53. Mortality, which was recorded in four studies involving 2020 participants), was again only slightly reduced in the CPAP arm (odds ratio, 0.85) and nonsignificant (P =.72). Stroke was similarly slightly lower but also nonsignificant. However, both systolic and diastolic blood pressures were significantly reduced, at -2.03 mm Hg and -1.79 mm Hg, respectively.

Viewpoint

Cardiovascular diseases and OSA often go together, particularly because cigarette smoking and obesity are highly prevalent in both disorders.[2] In addition, whenever body mass index and the presence of type 2 diabetes mellitus were recorded included in the meta-analysis, they were almost always present as well. One might say, parenthetically, that whenever a healthcare provider is confronted with one of these conditions, he or she should consider the presence of other comorbidities, regardless of whether they were presenting conditions.

Previous studies have addressed the question of whether using CPAP to treat patients with cardiac conditions and OSA would ameliorate the cardiovascular component and found results similar to the present ones—that is, CPAP had little benefit in terms of cardiovascular events and mortality, but provided some reduction in blood pressure. It is well known that weight loss improves OSA,[3] but it now appears clear that the benefit of CPAP therapy does not extend to a significant reduction in cardiovascular outcomes.

There appears to be a connection between the disorders in question—namely that cardiovascular disorders, obesity, OSA, type 2 diabetes, and possibly metabolic syndrome and COPD are comorbidities.

[sptrout]

A rather depressing study to read on a Sunday morning. Many of us probably thought that the opposite was true:

"Previous studies have addressed the question of whether using CPAP to treat patients with cardiac conditions and OSA would ameliorate the cardiovascular component and found results similar to the present ones—that is, CPAP had little benefit in terms of cardiovascular events and mortality, but provided some reduction in blood pressure. It is well known that weight loss improves OSA,[3] but it now appears clear that the benefit of CPAP therapy does not extend to a significant reduction in cardiovascular outcomes."

Below is a link to the complete study for those who like to read medical studies to try to get to the bottom of the "headlines".

http://download.springer.com/static/pdf ... 72da4d0922

[sptrout]

Sorry, but when I tried the link I just posted, it did not go directly to the "pdf" file as expected. However, pushing the "Download PDF" button at the site linked to will get you to the complete study.

[chunkyfrog]

I don't really care. Cpap makes me feel like life is worth living.
Untreated, I sometimes just wanted to die.
Statistics, schmetistics!

[Lucyhere]

Hmmm... wonder how much the placebo effect enters into it?

[BlackSpinner]

Hmmm... wonder how much the placebo effect enters into it?

With what?
If I don't use my cpap machine my SPO drops immediately below 70%, and that is drifting off sitting up.

[Julie]

If you read the article (link) they do address the placebo, but say it doesn't do much - not as much as it usually does in other trials.

[Lucyhere]

Hmmm... wonder how much the placebo effect enters into it?

With what?
If I don't use my cpap machine my SPO drops immediately below 70%, and that is drifting off sitting up.

Yes, I know... which is why I slap my mask on every nite. Even with my data pretty darn good (according to most studies I've looked at), and the relief that my oxygen level is where it should be, I can't say that I 'feel' very much different than when I started this therapy over ten years ago. Intellectually, I feel better because... I'm doing what the newest studies tell me I should be doing, but as far as feeling any different (or better), nope. I'm sure that's why many people toss their machines in the closet and then hope for the best. It's a chore to do something that well, intellectually, you think may help... but in reality, no noticeable difference at all. I do think it's a different story if a person can say... wow... I feel like a new person, more energy, better memory etc. Could be that for some it isn't a placebo effect; but for others... ?? FWIW, my doctor thinks the same way... however, I suppose it's better to go with what we know than the huge amount we don't.

[BlackSpinner]

By the third month there was a huge difference for me. Software I had been having problems understanding was suddenly dead simple and obvious. The amount of quality code I was able to shake out in record time was also a pretty good bench mark. Years of dealing with pain taught me how to use the placebo effect and this wasn't the same thing at all.

And decades of disappointment at migraine drugs that didn't work or turned me into a zombie made sure I was very skeptical about this thing I was supposed to put on my face.

[Sir NoddinOff]

It's hard to get away from the indiscretions of our youth and middle years (or maybe, later years for some). Of course part of it our individual genetic make-up. Somehow they are always there in the background, haunting our lives like Deus ex machina.
https://en.wikipedia.org/wiki/Deus_ex_m ... %29_07.JPG

[Greendirt]

Cardiovascular diseases and OSA often go together, particularly because cigarette smoking and obesity are highly prevalent in both disorders.[2] In addition, whenever body mass index and the presence of type 2 diabetes mellitus were recorded included in the meta-analysis, they were almost always present as well. One might say, parenthetically, that whenever a healthcare provider is confronted with one of these conditions, he or she should consider the presence of other comorbidities, regardless of whether they were presenting conditions. ... There appears to be a connection between the disorders in question—namely that cardiovascular disorders, obesity, OSA, type 2 diabetes, and possibly metabolic syndrome and COPD are comorbidities.

Yep. The ultimate first world problem.

A wise man once told me most people kill themselves: mostly with hamburgers, Coke, smokes and their couch. Too much of which inevitably leads to those comorbidities.

The extreme levels of sugars, fats and other shite in the western diet, especially when coupled with minimised physical activity, make these things more likely than not.

Some get them by bad luck, but many as a consequence of choices made - too often in response to persuasive advertising, cheap prices for crap foods, and too many easy choices (like TV and internet forums) apart from physical activities.