Posted on 02/27/2024 9:24:59 AM PST by ConservativeMind
A study of people with obstructive sleep apnea suggests that high CPAP pressures may explain why the machines do not lower a patient's risk of heart disease, which is about two to three times higher than average.
Several years ago, studies started to suggest a problem with this hypothesis. In studies designed to understand CPAP's effect on the body, they found that levels of a pro-inflammatory factor, angiopoietin-2, do not decline with CPAP use. High levels of Ang2 have been linked in previous studies to a higher risk of stroke, coronary artery disease, vascular disease, and mortality.
…To Jelic, the pattern of Ang2 and other biomarkers in CPAP users resembled that from patients on high-pressure ventilators, and she hypothesized that high CPAP pressures may explain why the expected drop in heart disease didn't materialize.
Their analysis showed that Ang2 levels remained elevated in CPAP users, confirming Jelic's previous findings in smaller studies, and that high Ang2 levels were associated with a greater risk of cardiovascular disease 12 months into the study.
The patients with the highest Ang2 levels, the researchers then found, were those using higher CPAP pressures.
A standard CPAP prescription uses pressures ranging from 4 to 20 cm H2O with median pressures varying within that range. In the study, participants with median CPAP pressure between 4 and 7 had fewer cardiovascular events compared to participants using pressures of 8 or higher.
Because CPAP is known to expand the lung, though not as dramatically as ventilators, Jelic thinks that stretched endothelial cells in the lung release extra Ang2.
Currently, most physicians adjust CPAP pressures to eliminate all obstructive episodes during sleep. But Jelic says that lower pressures may reduce Ang2 and produce the same sleep and fatigue improvements, even if some obstructive episodes break through.
(Excerpt) Read more at medicalxpress.com ...
Me too, my start was a stint in hospital and a prescription for a ventilator. My sleep study put my obstruction above the range for CPAP so I use a SW algorithm that assures volume. This means pressure is raised as required to ventilate my lungs. This means pressure is sometimes above the levels in this study but it drops the pressure when ventilation is easier.
The machine is called a Trilogy 100
I believe it has improved my sleep and prolonged my life
So it goes
KC
Cart before the horse. Many Cpap users, including myself, are overweight.
So tremendous—you and your wife really did yourselves a great favor by figuring out what to take and when. Such a great example you set for those with the wisdom to follow. Suffice it to say, This Guy knows from his own and another family example that pristine D levels are hugely important, so kudos for you on the Vitamin D question. Just so impressed.
First, looking at the graph, is it not possible to hypothesize that higher pressures could come because of more severe apnea, with greater inflammation to follow accordingly?
Second, many apnea patients do not optimize their machine settings. An AHI of 5, considered the boundary between treatable and acceptable events per hour, is something which I find to be ridiculously high, and is most certainly an arbitrarily determined figure.
My AHI bounces between 0.2 and 0.1, typically. Inspiratory Muscle Training made a big difference. So did moving the lower pressure on the apap range to just above my titrated pressure, and the higher pressure 4 cm above that. I download my data each morning on a data card, plug it into my computer, and analyze with an amazing open source program called OSCAR. I avoid heated humidity (it can swell airways) and can turn the setup into a petri dish. Unheated humidity is my best friend. I'll stop short of making the above universal recommendations as I'm not a physician (do your own DD).
My cardio system does just fine, as I have no problem running, hiking, skiing, biking etc. My APAP influences my cardio health in a positive way.
The pressure change would seem an easy thing to try with your doctor’s help.
Every machine I’ve had from the VA (since 2006) has automatic adjustable pressure setting.
If I’m congested or laying weird, it ups the pressure.
If I’m not congested or laying with a constricted chest, it lowers the pressure.
I got my first CPAP when my son was playing baseball 15 years ago. We went to Kansas City and I left my machine at home. Almost fell asleep a half dozen times on the way home. I’ll never sleep without one again just for that reason.
He returned in a hearse.
I had not had a pap-free evening before the time, and the horrible result reenforced my good habit. Never travel without your sweet dream machine (xpap).
Agree 100%. I threw away a mask strap thinking I had a spare one & I drove over to Omaha the next day to get a new one. It goes where I go today.
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