Does CPAP Eliminate Cardiovascular Risks of Sleep Apnea?

I doubt anyone (diagnosed with OSA or NOT) is 100% apnea free, 100% of the time.

My own long-term 0.4 AHI average (I have 0.0 AHI 3 to 4 nights per week) is good enough for government work ... and for me too.

DreamStalker wrote:I doubt anyone (diagnosed with OSA or NOT) is 100% apnea free, 100% of the time.

So, diagnosed or not, CPAP still does not eliminate ALL their risk.

(Gotta run....THIS part of the government stops working at 3:00...)

jnk wrote: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

I agree with you that 0.0 is unexpected, and I was exaggerating only to make a point. There is a LOT that I don't understand about OSA!

My point was: How do you separate OSA cardiovascular issues from the other issues I (and the Dr.) raised such as: Genetics, Health, Diet, etc???

Here's a hypothetical scenario: I'm overweight, have a disposition for cardiovascular disease, and don't eat healthy and have had OSA for 5+ years. My OSA is treated well, and I have an average AHI of 0.8. I die of a stroke at 2:05 am right after the software shows a minor 10 second apnea. What was the root cause, OSA, or my other issues? I doubt even a autopsy could resolve the issue.

Based upon the above scenario, how can you say "yes" my OSA "eliminated" my OSA related cardiovascular issues? I would say that it "reduced it significantly", but wouldn't use the word "eliminated".

Maybe I'm just caught on the word "eliminated" because it seems so final, conclusive, and definitive, where we know that OSA is much mis-understood.

Tielman wrote:

jnk wrote: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

I agree with you that 0.0 is unexpected, and I was exaggerating only to make a point. There is a LOT that I don't understand about OSA!

My point was: How do you separate OSA cardiovascular issues from the other issues I (and the Dr.) raised such as: Genetics, Health, Diet, etc???

Here's a hypothetical scenario: I'm overweight, have a disposition for cardiovascular disease, and don't eat healthy and have had OSA for 5+ years. My OSA is treated well, and I have an average AHI of 0.8. I die of a stroke at 2:05 am right after the software shows a minor 10 second apnea. What was the root cause, OSA, or my other issues? I doubt even a autopsy could resolve the issue.

Based upon the above scenario, how can you say "yes" my OSA "eliminated" my OSA related cardiovascular issues? I would say that it "reduced it significantly", but wouldn't use the word "eliminated".

Maybe I'm just caught on the word "eliminated" because it seems so final, conclusive, and definitive, where we know that OSA is much mis-understood.

My point is that someone getting successful treatment for OSA may be breathing and sleeping as well as, maybe even better than, a person without OSA.

Remember that machine software may show "events" that would not be counted as such in a PSG. For example, a sleep onset central might be ignored in a PSG, as I understand it, even though it would be counted as an apnea by a home machine.

I believe that after the damaging obstructive events are eliminated by successful PAP therapy to the point of making a person pretty much like everyone else in that respect, a person can be said to have "eliminated" the risks caused by the bad sleep and bad breathing, especially in comparison to what someone with untreated OSA experiences. Although, DreamStalker makes a good point, in that it may be that OSA is caused by, or is a manifestation of, whatever also causes CVD. So, in that sense, it may be that "eliminating" the OSA is not, in and of itself, as significant a factor in lowering risks as my oversimplified mental model might suggest. Anything involving causation is difficult to determine when one is only working within the realm of statistical relationships. Thus the need for more studies. I hope the funding for that doesn't dry up. There needs to be an infusion of fresh air to keep the scientists from nodding off on this stuff, as it were, if you will.

jnk wrote: My point is that someone getting successful treatment for OSA may be breathing and sleeping as well as, maybe even better than, a person without OSA.

Remember that machine software may show "events" that would not be counted as such in a PSG. For example, a sleep onset central might be ignored in a PSG, as I understand it, even though it would be counted as an apnea by a home machine.

I believe that after the damaging obstructive events are eliminated by successful PAP therapy to the point of making a person pretty much like everyone else in that respect, a person can be said to have "eliminated" the risks caused by the bad sleep and bad breathing, especially in comparison to what someone with untreated OSA experiences. Although, DreamStalker makes a good point, in that it may be that OSA is caused by, or is a manifestation of, whatever also causes CVD. So, in that sense, it may be that "eliminating" the OSA is not, in and of itself, as significant a factor in lowering risks as my oversimplified mental model might suggest. Anything involving causation is difficult to determine when one is only working within the realm of statistical relationships. Thus the need for more studies. I hope the funding for that doesn't dry up. There needs to be an infusion of fresh air to keep the scientists from nodding off on this stuff, as it were, if you will.

Seems to be me are both splitting hairs. Your taking the position that successful treatment of OSA eliminates OSA (I think most folks on this board would disagree with that, it' takes daily work to keep the AHI numbers low, and many folks including myself have days at or above 3.0 AHI). I'm taking the position that "eliminated" is final, complete and is like a cancer going into remission, where it's probably more like diabetes that's controlled.

Both of us are probably right, and both of us are probably wrong. I'll agree that you make a very good point!

Let's hope more studies, research and testing will help to resolve these questions, and give all of us better health, and better health care!

Tielman wrote: . . . Both of us are probably right, and both of us are probably wrong. . . .

Yep. Or as one of the Google quotes for this week put it:

"The truth is always a compound of two half-truths, and you never reach it, because there is always something more to say."--Tom Stoppard.

Thus the need for forums.

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...

Well, if one wanted to be pedantic -- and why not, it's Friday -- he could argue as follows. OSA is defined by meeting an AHI threshold: 5 events per hour. A person who consistently has an AHI lower than 5 doesn't have OSA. So it really shouldn't be necessary to push the AHI down to 0 to eliminate the risk associated with OSA. Pushing the AHI below 5 eliminates the risk of OSA, leaving only the normal risk faced by people without OSA.

PST wrote: . . . OSA is defined by meeting an AHI threshold: 5 events per hour. . . .

As I understand it, someone with an AHI even higher than that would not likely be diagnosed OSAS if he was otherwise asymptomatic. It is a sliding scale without a clear demarcation. Different docs in different countries may use slightly different criteria, so defining who is OSA from who isn't is less than an exact science. Is snoring a risk factor for cardiovascular disease? Is UARS? I don't know. I don't know if enough studies have been done for anyone to know. The definitions may all be too new. The question in the article was about severe obstructive sleep apnea.

Death eliminates cardiovascular risks. Everything else increases or decreases cardiovascular risks.

On the other hand, if eating Big Macs increases cardiovascular risks, and you stop eating Big Macs, then you have eliminated the cardiovascular risks of eating Big Macs. Other than the ones you already ate.

Of course, that may not mean much if you simply start eating Whoppers instead. But the statement remains true nonetheless.

May I interrupt this debate to bring you a different form of entertainment? I'll take that to me Yes.

Ok which one of you scholars knows the definition of the "Speed of Light'?

LinkC wrote:(Gotta run....THIS part of the government stops working at 3:00...)

After reading the above, I will say it is likely the Speed at which LinkC moves at 2:59

Now resuming the normal debating....

DreamStalker wrote:I doubt anyone (diagnosed with OSA or NOT) is 100% apnea free, 100% of the time.

I have to agree with PST than <5 AHI is thought to be the "norm". So when I keep my AHI <1 - am I above the norm or below the norm?

As you were...

GumbyCT? "Norm"? In the same post?!! I'm sorry, but I don't understand the question!

I think for many docs you have to have excessive daytime sleepiness/fatigue AND an AHI over 5 DURING A PSG to be considered OSA. An AHI over 5 don't get you nuthin' without some symptoms, as I understand it.

SleepingUgly has a great point, though. Getting up in the mornings brings cardiovascular risks.

jnk wrote:On the other hand, if eating Big Macs increases cardiovascular risks, and you stop eating Big Macs, then you have eliminated the cardiovascular risks of eating Big Macs. Other than the ones you already ate.

Of course, that may not mean much if you simply start eating Whoppers instead. But the statement remains true nonetheless.

Your diet in general increases/decreases your cardiovascular risks, as a function of other variables, most likely. Most relationships between variables such as those under discussion are likely moderated or mediated by other variables. It's rare to find a one variable (e.g., apnea) directly causing another (e.g., death) without some mediating or moderating variables (e.g., diet, genetics, obesity, oxygen saturation, other co-morbid diseases, age, etc.).

I think the best you can do is try to address all those that are under your control and are known to be significant risk factors (e.g., SDB, diet/weight, but not genetics, etc).

Now, back to my Big Mac...

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 read it the same way JNK. Helps reduce the risks that apnea directly creates....not the other risks.

LinkC wrote:...Unless CPAP stops ALL your apneas (0.0AHI), then it has NOT eliminated ALL the risk associated with OSA...

I wonder if it's not so much the events that are important but the O2 desaturations. I had only hypops in my PSG but significant desats and at the time of apnea diagnosis a BP of 210/110...any wonder why I pee'd 8-10 times/night . Oh the joys of CPAP therapy that stopped that particular habit the first night