Does CPAP Eliminate Cardiovascular Risks of Sleep Apnea?

Maybe it has already been posted and discussed and I missed the thread, but I only recently saw the "Ask the Doctors" section of the Cleveland Clinic Heart Advisor, a newsletter, January 2010, Vol. 13, No. 1, in which the following question was addressed:

"I have severe sleep apnea, but use a CPAP machine every night. Is the machine enough to eliminate the cardiovascular risks caused by sleep apnea?"

Here is the answer given:

Obstructive sleep apnea (OSA), the most common form of sleep apnea, is a risk factor for hypertension, heart failure, cardiac arrhythmias, stroke, and coronary artery disease (CAD). It is clear from multiple trials that use of continuous positive airway pressure (CPAP) in OSA patients reduces hypertension. With regards to the hazards of CAD, particularly angina, heart attack, and sudden death, several small observational trials suggest a benefit of CPAP in lowering their incidence. However, results of large, randomized controlled trials are still needed to firmly establish reduced risk. Overweight patients with OSA should also keep in mind that losing weight will accrue additional cardiovascular benefits, above and beyond what the very-useful CPAP appears to yield.

jnk wrote:

"I have severe sleep apnea, but use a CPAP machine every night. Is the machine enough to eliminate the cardiovascular risks caused by sleep apnea?"

Short answer: NO

The key word being "eliminate". Other factors (such as genes, weight, diet, and exercise) come into play with regards to cardiovascular risks, just as anyone without OSA might have.

Tielman wrote:

jnk wrote:

"I have severe sleep apnea, but use a CPAP machine every night. Is the machine enough to eliminate the cardiovascular risks caused by sleep apnea?"

Short answer: NO

The key word being "eliminate". Other factors (such as genes, weight, diet, and exercise) come into play with regards to cardiovascular risks, just as anyone without OSA might have.

I would agree.

CPAP use "reduces" rather than "eliminates" CV risk(s) and proper management of the "other" factors are more likely to reduce the risks much more.

For me, the key phrase in the question was "risks caused by sleep apnea."

And the indications seem to be: YES. Though, naturally, CPAP does not eliminate the risks from other sources, such as being overweight.

But maybe I misread the answer.

jnk wrote:For me, the key phrase in the question was "risks caused by sleep apnea."

And the indications seem to be: YES. Though, naturally, CPAP does not eliminate the risks from other sources, such as being overweight.

But maybe I misread the answer.

Please explain. Are you saying the risks/hazards of CAD listed in the answer are untrue, incomplete, surprising, something else?

jnk wrote:For me, the key phrase in the question was "risks caused by sleep apnea."

And the indications seem to be: YES. Though, naturally, CPAP does not eliminate the risks from other sources, such as being overweight.

But maybe I misread the answer.

I would agree with you if the normal AHI of someone on CPAP was 0.0, but we all know that's not the case.

The way I see it, you are all correct. Yes, there other risk factors, but the posed question is specific to the risks caused by sleep apnea. Is ones risk of hypertention eliminated, or just the portion of that risk caused by sleep apnea? Phraseology. What was the intent of the one asking? Hmmm...

DreamStalker wrote:

jnk wrote:For me, the key phrase in the question was "risks caused by sleep apnea."

And the indications seem to be: YES. Though, naturally, CPAP does not eliminate the risks from other sources, such as being overweight.

But maybe I misread the answer.

Please explain. Are you saying the risks/hazards of CAD listed in the answer are untrue, incomplete, surprising, something else?

Fair question. Here is my position:

I am only saying that if a person's treatment for OSA is successful to the point that he no longer experiences bad breathing and bad sleep (relatively speaking, of course), it would seem reasonable to me to conclude that bad breathing and bad sleep are no longer causing increased risk of disease for that person, since it isn't occurring any longer. And as I read the answer in the publication I quoted, that appears to be what the data is showing so far, although further study is needed to prove it.

But hey, my logic could be flawed. Or oversimplified. It often is. That's why I post stuff here.

Keep me honest!

jeff

Tielman wrote:

jnk wrote:For me, the key phrase in the question was "risks caused by sleep apnea."

And the indications seem to be: YES. Though, naturally, CPAP does not eliminate the risks from other sources, such as being overweight.

But maybe I misread the answer.

I would agree with you if the normal AHI of someone on CPAP was 0.0, but we all know that's not the case.

I agree that no one on the planet breathes perfectly while asleep. So I also believe that most everyone, even those considered to have no signs of OSA, will have some events during a PSG. Therefore, true O.O AHI, as defined in a PSG, may be an unrealistic goal, even for those without signs of OSA.

But there is a lot about this stuff I don't understand.

jeff

kteague wrote:The way I see it, you are all correct. Yes, there other risk factors, but the posed question is specific to the risks caused by sleep apnea. Is ones risk of hypertion eliminated, or just the portion of that risk caused by sleep apnea? Phraseology. What was the intent of the one asking? Hmmm...

Good points.

I think the way the answer was phrased in the publication is brilliant.

On the one hand, some people reason, wrongly: "I don't have to worry about losing weight or any other risk factors, since I am doing CPAP."

On the other hand, some people reason, wrongly: "Why should I bother doing CPAP, since I have other risk factors."

To me, the right way to reason is to say: "I am using CPAP to breathe better and sleep better at night, so now I am in a better position to do positive things about my health."

As I read it, the answer given addresses that approach without giving grounds for excuses either way, while at the same time acknowledges that more study is needed on this complicated issue.

For me, this is an important point, because people with successfully treated OSA get lumped in with those not treating their OSA. Scientifically, it needs to be proved that someone successfully treating his OSA should be classed in with those who do not have it.

That is my angle.

jeff

jnk wrote:

DreamStalker wrote:

jnk wrote:For me, the key phrase in the question was "risks caused by sleep apnea."

And the indications seem to be: YES. Though, naturally, CPAP does not eliminate the risks from other sources, such as being overweight.

But maybe I misread the answer.

Please explain. Are you saying the risks/hazards of CAD listed in the answer are untrue, incomplete, surprising, something else?

Fair question. Here is my position:

I am only saying that if a person's treatment for OSA is successful to the point that he no longer experiences bad breathing and bad sleep, it would seem reasonable to me to conclude that bad breathing and bad sleep are no longer causing increased risk of disease for that person, since it isn't occurring any longer. And as I read the answer in the publication I quoted, that appears to be what the data is showing so far, although further study is needed to prove it.

But hey, my logic could be flawed. Or oversimplified. It often is. That's why I post stuff here.

Keep me honest!

jeff

oky doky. I re-read the thread title and yes the question is specific to CAD risks due specifically to OSA.

So I stand corrected. I misread the question.

DreamStalker wrote: . . . oky doky. I re-read the thread title and yes the question is specific to CAD risks due specifically to OSA.

So I stand corrected. I misread the question.

Spoken as the true gentleman and scholar that you are, DreamStalker. A rare combination, these days, IMO.

I very much appreciate the input on the post and any further observations on the subject from you.

jeff

Jeff -

Certainly you jest about my supposed rare combination.

My only observation/comments would be that I still think that CAD and all other degenerative health conditions are basically genetic expressions of our encoded cellular DNA. Our genes respond to our environment (food, exercise, stress, and of course sleep) through our hormonal interface. Some of us have less than optimal genetics and some of us have less than optimal environmental factors and so some of us find ourselves suffering from OSA, CVD, diabetes, and the many other health conditions which we discuss on this great forum daily.

And what really makes this forum so great is that we have great members like you who post "stuff" here to discuss and share experiences, opinions, and knowledge about health, society (relative to entire political and religious spectrum), and general entertainment.

So keep the stuff coming and lets keep everyone honest.

However, Tielman made an excellent point that may have been lost in the semantics debate and back patting.

Unless CPAP stops ALL your apneas (0.0AHI), then it has NOT eliminated ALL the risk associated with OSA. I've never known ANY CPAPer to claim 100% elimination of apnea events...

LinkC wrote:However, Tielman made an excellent point that may have been lost in the semantics debate and back patting.

Unless CPAP stops ALL your apneas (0.0AHI), then it has NOT eliminated ALL the risk associated with OSA. I've never known ANY CPAPer to claim 100% elimination of apnea events...

This was my response to Mr. Tielman, a few posts up, LinkC:

jnk wrote:

Tielman wrote:

jnk wrote:For me, the key phrase in the question was "risks caused by sleep apnea."

And the indications seem to be: YES. Though, naturally, CPAP does not eliminate the risks from other sources, such as being overweight.

But maybe I misread the answer.

I would agree with you if the normal AHI of someone on CPAP was 0.0, but we all know that's not the case.

I agree that no one on the planet breathes perfectly while asleep. So I also believe that most everyone, even those considered to have no signs of OSA, will have some events during a PSG. Therefore, true 0.0 AHI, as defined in a PSG, may be an unrealistic goal, even for those without signs of OSA.

But there is a lot about this stuff I don't understand.

jeff

Consider your back patted, too, LinkC.