Pressure and the heart - any truth to this?

earlvillestu wrote: ↑

Fri Sep 09, 2022 11:40 am

I'm using a ResMed AirSense 11 AutoSet. Couldn't set it at 25 even if I wanted to.

Right. Nobody's does.

I've never seen or talked to any of them. My only contacts have been with the aforementioned RN...

So telehealth her and ask her what she meant. That'll solve the whole issue. Ask her specifically what pressure creates issues cause I don't think she should throw something like that on the table without some basis.

babydinosnoreless wrote: ↑

Fri Sep 09, 2022 10:02 am

I know for some reason you guys feel the need to whip out your measuring tapes ...

Well that depends-- REM or NREM?

OK NREM 2.7" REM 3.2".

Whew. I thought that was going to be difficult but turns out it wasn't that hard.

Rubicon wrote: ↑

Sat Sep 10, 2022 2:14 am

So telehealth her and ask her what she meant. That'll solve the whole issue. Ask her specifically what pressure creates issues cause I don't think she should throw something like that on the table without some basis.

Thanks for the response, but telehealth visit co-pay is $50, so I think I'll pass, since I'm comfortable with the advice I've received here. I suspect that Pugsy's analysis of her reason for the alarm ("I think it was said to scare the bejesus out of someone because the medical care team (or at least that RN) was on a big power trip and didn't believe patients were smart enough to figure out pressure needs on their own.") is spot-on.

earlvillestu wrote: ↑

Sat Sep 10, 2022 4:07 am

Rubicon wrote: ↑

Sat Sep 10, 2022 2:14 am

So telehealth her and ask her what she meant. That'll solve the whole issue. Ask her specifically what pressure creates issues cause I don't think she should throw something like that on the table without some basis.

Thanks for the response, but telehealth visit co-pay is $50, so I think I'll pass...

Well next time you talk to her. It's our job to educate where necessary.

Rubicon wrote: ↑

Sat Sep 10, 2022 2:23 am

babydinosnoreless wrote: ↑

Fri Sep 09, 2022 10:02 am

I know for some reason you guys feel the need to whip out your measuring tapes ...

Well that depends-- REM or NREM?

OK NREM 2.7" REM 3.2".

Whew. I thought that was going to be difficult but turns out it wasn't that hard.

earlvillestu wrote: ↑

Thu Sep 08, 2022 7:00 am

First, some background, and then a question.



I've done quite a bit of reading about CPAP, and I've never come across that claim. Is there any truth to it?

=
I would ignore Rubicon's Remarks in their entirety.
There are no scientific studies that have linked cardiovascular issues to "pressure settings" on a PAP machine.
I recommend changing to Polysomnography clinic, to set your mind at rest because if your own pressure titration provides for a good night sleep and you are happy with your AHI, then you have succeeded.

"According to The New England Journal of Medicine, a research team monitored just over 2700 sleep apnea patients and concluded that using a CPAP machine did not improve cardiovascular health. In addition, these machines did cause heart failure or heart attacks in this large scale study."

All the best

Can the Airsense 11 Auto get up to 25 cm?
I had no idea.
Since rubicon is never wrong, I am baffled.

From the above linked NEJM paper:
All emphasis mine

In the CPAP group, the mean duration of adherence to CPAP therapy was 3.3 hours per night, and the mean apnea–hypopnea index (the number of apnea or hypopnea events per hour of recording) decreased from 29.0 events per hour at baseline to 3.7 events per hour during follow-up

Patients were recruited at 89 clinical centers in 7 countries; eligibility criteria included an age between 45 and 75 years, a diagnosis of coronary artery disease or cerebrovascular disease, and a diagnosis of moderate-to-severe obstructive sleep apnea.

Potential participants were required to have a minimum level of adherence to CPAP therapy, which was defined as an average of 3 hours per night, during a 1-week run-in period in which sham CPAP was used (i.e., CPAP at subtherapeutic pressure)

And reading the detailed inclusion / exclusion criteria https://www.nejm.org/doi/suppl/10.1056/ ... pendix.pdf is even more
mind boggling.

Who would'a thunk: Mean usage of 3.3 hours per night of CPAP does not heal pre-existing coronary artery disease or cerebrovascular disease.

Amazing, isn't it???

chunkyfrog wrote: ↑

Sun Sep 11, 2022 9:48 pm

Can the Airsense 11 Auto get up to 25 cm?
I had no idea.
Since rubicon is never wrong, I am baffled.

The original question was: Pressure and the heart - any truth to this?
Rubicon replied to the question as it was put.
The original question was not "is the AP-RN knowlegeable? was she right in applying her knowledge to my specific case as an APAP user?"

Some people on this forum can safely be ignored. Some even should be ignored.

But never ever Rubicon ...or any of his incarnations...

He has a habit of changing his name every 1000 posts. And for the curious, (or the nostalgic...) all you have to do to find Rubicon's previous incarnations (and posts) is sort the members by number of posts and focus on the names who have 1000 (or 1000 and a bit posts).

Rubicon loves to baffle, or challenge, or, as Pugsy put it, sometives writes in code. He should always be read carefully and in context. Rubicon also takes time to read carefully and attempts to help.

Simply put for anyone who is new or relatively new to this forum: ignore Rubicon at your peril.

chunkyfrog wrote: ↑

Sun Sep 11, 2022 9:48 pm

Since rubicon is never wrong...

Well, when I said

Rubicon wrote: ↑

Sat Sep 10, 2022 2:23 am

OK NREM 2.7" REM 3.2".

I was exaggerating.

GearChange seems to still be hemorrhaging from our last encounter.

ozij wrote: ↑

Sun Sep 11, 2022 11:18 pm

He has a habit of changing his name every 1000 posts. And for the curious, (or the nostalgic...) all you have to do to find Rubicon's previous incarnations (and posts) is sort the members by number of posts and focus on the names who have 1000 (or 1000 and a bit posts).

You're too kind, o.

Now that boy should be kept busy looking for errors for awhile. I guess he's trying to prove he's >3.2"

OTOH, like my pappy used to say, "If you're not making mistakes, you're not taking enough risks".

Today's interesting tidbit. In re:

Rubicon wrote: ↑

Thu Sep 08, 2022 7:08 am

Once you start hitting about 25 cmH2O.

Very high pressures start to impinge upon the capillary bed, and blood starts to back up behind right heart and accumulate in the periphery.

Do a search on "CPAP (or PEEP) cardiac output".

There is no question that once you start adding CPAP/PEEP cardiac output will decrease. What happens after that depends on a number of factors, most notably amount of CPAP and the fluid status of the patient. Alveoli are positively inflated (vs normal inflation by negative pressure) until the capillary bed starts getting squashed and blood flow is impeded.

Blood return to the heart is achieved (or at least greatly enhanced) by inspiration, as negative pressure draws blood into right heart. Adding CPAP and knocking out respiratory drive with controlled BiPAP can create unstable hemodynamics.

Low levels of CPAP should produce no notable changes (that said, the clinician should be checking blood pressure during initial CPAP titrations. Every now and then somebody's BP will crash cause they're a little dry)(although if they aren't checking no skin off my butt it's not my responsibility).

Given enough CPAP you will crash anybody's BP. But again, normally that's more than a run-of-the-mill CPAP machine can produce.

Is that what the RN NP Whoever meant?

Oh look at time. Gotta go fishing.

Next up: OK that's fine, but can the exact opposite happen?

ozij wrote: ↑

Sun Sep 11, 2022 10:53 pm

From the above linked NEJM paper:
All emphasis mine

In the CPAP group, the mean duration of adherence to CPAP therapy was 3.3 hours per night, and the mean apnea–hypopnea index (the number of apnea or hypopnea events per hour of recording) decreased from 29.0 events per hour at baseline to 3.7 events per hour during follow-up

Patients were recruited at 89 clinical centers in 7 countries; eligibility criteria included an age between 45 and 75 years, a diagnosis of coronary artery disease or cerebrovascular disease, and a diagnosis of moderate-to-severe obstructive sleep apnea.

Potential participants were required to have a minimum level of adherence to CPAP therapy, which was defined as an average of 3 hours per night, during a 1-week run-in period in which sham CPAP was used (i.e., CPAP at subtherapeutic pressure)

And reading the detailed inclusion / exclusion criteria https://www.nejm.org/doi/suppl/10.1056/ ... pendix.pdf is even more
mind boggling.

Who would'a thunk: Mean usage of 3.3 hours per night of CPAP does not heal pre-existing coronary artery disease or cerebrovascular disease.

Amazing, isn't it???

I saw that. What a poorly designed study.

I can’t believe that’s what qualifies as research. I also can’t believe that New England Journal of Medicine would publish that crap.

I bet the comments about the study of shredding them to bits. Awful.

I couldn’t tell. Maybe I could spend a long time reading it but it was very unclear to me as to whether those people on the study even have obstructive sleep apnea.

lynninnj wrote: ↑

Mon Sep 12, 2022 6:01 am

I couldn’t tell. Maybe I could spend a long time reading it but it was very unclear to me as to whether those people on the study even have obstructive sleep apnea.

They did ...if you accept their diagnostic criteria and tools.

NEJM Paper wrote: Patients were recruited at 89 clinical centers in 7 countries; eligibility criteria included an age between 45 and 75 years, a diagnosis of coronary artery disease or cerebrovascular disease, and a diagnosis of moderate-to-severe obstructive sleep apnea. The diagnosis of moderate-to-severe obstructive sleep apnea, which was defined as an oxygen desaturation index (the number of times per hour during the oximetry recording that the blood oxygen saturation level drops by ≥4 percentage points from baseline) of at least 12, was established with the use of a home sleep-study screening device (ApneaLink, ResMed) and was confirmed by review of the data at a central core sleep laboratory