CPAPtalk.com

elader wrote:Yeah, there is lots of individual evidence - treatment lowers BP, etc. But you know, when you see these studies that say 'OSA causes 3X more risk of..." - how do they know that? Are these people who they know have OSA and are not treated?

Think they ever followed two groups of people, treated and untreated??

One study I've found and will take another look at this weekend shows very definitely that CPAP use in people with AHI >-20 "Continuous Positive Airway Pressure Treatment in Sleep Apnea Prevents New Vascular Events After Ischemic Stroke." In this case the control group was a group of patients who could not tolerate CPAP and this control group shows a 5fold greater occurrence of new vascular events over the mean 2 year study.


One study I did download last night but have not had a chance to read yet involved congestive heart failure patients with OSA. 1/2 the participants were treated with CPAP, the other 1/2 were not over a period of one month. In the untreated group, there was no significant change. In the treated group, the ejection fraction increased by an average of 8 points (when you're at 37%, 8 points can mean a whole lot! An excerpt from the abstract:

"The subjects were then randomly assigned to receive medical therapy either alone (12 patients) or with the addition of continuous positive airway pressure (12 patients) for one month. The assessment protocol was then repeated. RESULTS: In the control group of patients who received only medical therapy, there were no significant changes in the severity of obstructive sleep apnea, daytime blood pressure, heart rate, left ventricular end-systolic dimension, or left ventricular ejection fraction during the study. In contrast, continuous positive airway pressure markedly reduced obstructive sleep apnea, reduced the daytime systolic blood pressure from a mean (+/-SE) of 126+/-6 mm Hg to 116+/-5 mm Hg (P=0.02), reduced the heart rate from 68+/-3 to 64+/-3 beats per minute (P=0.007), reduced the left ventricular end-systolic dimension from 54.5+/-1.8 to 51.7+/-1.2 mm (P=0.009), and improved the left ventricular ejection fraction from 25.0+/-2.8 to 33.8+/-2.4 percent (P<0.001). CONCLUSION: In medically treated patients with heart failure, treatment of coexisting obstructive sleep apnea by continuous positive airway pressure reduces systolic blood pressure and improves left ventricular systolic function. Obstructive sleep apnea may thus have an adverse effect in heart failure that can be addressed by targeted therapy."\

Given hubby's heart problems, this one is getting a very thorough read this weekend.

How about a study on if you go from years of non-treatment to being consistent on treatment, what are your chances of death if you miss a night versus never starting treatment. What I mean is do you build a tolerance to the side effects of non-treated sleep apnea over time.

I ask because if I miss a night now for whatever reason I wonder how the hell I made it so long!

I also found out the other night that a night of really bad leaking (Like one of the nasal pillows ends up outside your nostril) is worse than no treatment at all. I must have tossed and turned all night and my entire back is still killing me from it. My chin strap also slipped off and my mouth and throat were so dry it hurt. Not to mention the headache and dry eye from it blowing in my eye all night. I can't seem to keep this darn swift lt pillow in my nose all the sudden. I had it working good for a month.

Joy wrote: Many clinical trials will never be done also because it would be unethical to subject the control group (without treatment) to the danger of remaining untreated . . . and that is why a lot of, otherwise helpful, CPAP studies haven't been done.

Debjax responded:
Actually, that happens in most clinical trials that I've read about..there is always a control group who does not get treatment (in meds, they get a placebo). Necessary to see if the meds really do work or is it a placebo effect?

Control groups are necessary in a study for comparison purposes, yes. I was pointing out that sometimes a clinical trial is stopped . . . because one of the group is "dying like flies". When it is obvious that the control group's lives are in jeopardy by being in the control group (and not on the therapy or the med), it is considered unethical to continue. Likewise, some trials are NEVER EVEN BEGUN because it is already anticipated that this would happen. Thank goodness for that.

Joy

elader wrote:With all the health risks we know are associated with OSA, has anyone seen a study that says that proves that CPAP actually minimizes some or all of the serious risks? Yeah, I know it makes sense that it does, but has anyone proven it? I am thinking of stroke, heart attack.

This may be the best I can do for ya, elader:

"Therapy of the recurrent episodes of hypoxia, arousal and intrathoracic pressure variations, among other things, leads to the disappearance of the apnoea-associated increases in systemic and pulmonary arterial blood pressure, as well as the bradycardiac arrhythmias during sleep. With consequent nCPAP therapy, the daytime arterial blood pressure is reduced by 10 mmHg. . . . Remarkably, in the study including the patients with the highest mean AHI, the greatest decrease in blood pressure was found (10 mmHg). . . . Data from randomized controlled trials showing an effect of CPAP on mortality are still missing. A retrospective cohort study stratifying CPAP-treated patients according to compliance showed significantly higher 5-year mortality in noncompliant patients. Another historical cohort study comparing untreated with treated patients with severe OSA (mean AHI: 55) showed similar results. In a 10-year observational study, Marin et al. found a higher incidence of fatal as well as non-fatal cardiovascular events in untreated patients with severe OSA than in mild-moderate OSA or treated patients. . . . In conclusion, nCPAP therapy improves quality of life and effectively reduces daytime sleepiness. Especially in patients with high cardiovascular risk and severe sleep apnoea syndrome, CPAP holds the potential to reduce the rate of cardiovascular incidents."-- http://ndt.oxfordjournals.org/cgi/content/full/24/1/8

Recent article in our Toronto Globe&Mail.Dr.Douglas Bradley works at http://www.torontorehab.com
Article addresses a previously unproven theory,with simple treatment.

Health: SMALL DOSES: RESEARCH
Sedentary workers at risk for sleep apnea.
PAUL TAYLOR,GLOBE and MAIL
February 6, 2009
If your job chains you to a desk for much of the day, it could be increasing your chances of developing a serious sleep disorder, according to a landmark study by Toronto researchers.
The study revealed that fluids tend to accumulate in the legs of some people who spend a lot of time sitting. When they lie down at night the fluids redistribute to the upper body, including the neck. This fluid shift can narrow the airways and make it difficult to breathe, leading to obstructive sleep apnea.
"The idea that fluid movement is responsible for sleep apnea is, in some ways, revolutionary," said lead researcher Douglas Bradley, director of the Sleep Research Laboratory at the Toronto Rehabilitation Institute. "No one has considered this before."
Sleep apnea occurs when the soft tissues in the throat essentially collapse shut, blocking air flow. Those with the condition must wake briefly many times a night to gulp for air. They will have no recollection of waking, but suffer the consequences - fatigue the following day - of a poor sleep.

Even worse, sleep apnea puts an incredible strain on the heart and raises the risks of high blood pressure, heart attacks and strokes.
Doctors have long known that obese individuals, who snore a lot, are prone to sleep apnea. It has been assumed that extra flesh around the throat contributes to night-time breathing problems.
But researchers have been at a loss to explain fully why the disorder also afflicts people of normal weight. About 9 per cent of men and 4 per cent of women develop apnea - and 60 per cent of them are not obese.
Dr. Bradley's study may have finally solved the mystery. In an overnight sleep lab, his team examined 23 non-obese, apparently healthy men with the condition.
"We found the more fluid that moved out of the legs over night, the bigger their necks got and the worse sleep apnea they had," Dr. Bradley said. On average, the men's neck circumference increased by a centimetre.
The results, published in the American Journal of Respiratory and Critical Care Medicine, could lead to new treatment options to eliminate the disorder or reduce its severity.
For instance, just getting up and walking around more frequently could help reduce the buildup of fluid in the legs. Medication might also be used to minimize fluid retention. Or the head of the bed could be elevated to prevent night-time fluid shift.
Right now, the main method of treating sleep apnea is with a CPAP (continuous positive airway pressure) device that blows pressurized air into the throat to keep it open. But many patients find it difficult to sleep with a mask strapped to their face.

Global News Video:http://s144.photobucket.com/albums/r182 ... alth_1.flv