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chrisdh79 OP t1_jc6nczp wrote

From the article: A new study by Columbia University researchers suggests that cholesterol-lowering drugs called statins have the potential to reduce heart disease in people with obstructive sleep apnea regardless of the use of CPAP machines during the night.

CPAP (continuous positive airway pressure) therapy improves sleep quality and reduces daytime fatigue in people with obstructive sleep apnea. But based on findings from several recent clinical trials, CPAP does not improve heart health as physicians originally hoped.

Alternative methods to reduce heart disease in sleep apnea patients are urgently needed, because the condition is known to triple the risk of having a heart attack, stroke, or another serious cardiovascular event.

Statins (a class of cholesterol-lowering drugs) may be one such method, according to the new study, led by Sanja Jelic, MD, associate professor of medicine at Columbia University Vagelos College of Physicians and Surgeons.

The study included 87 people with recently diagnosed obstructive sleep apnea who were being treated with CPAP. The patients were randomized to receive treatment with either statins or a placebo.

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estranho t1_jc6q6r6 wrote

> CPAP does not improve heart health as physicians originally hoped.

and

>"CPAP also seems to have negative effects on the cardiovascular system."

This is a bit concerning, not only did they find that CPAP doesn't necessarily improve heart health, it can also have a negative impact on it. I've been a CPAP user for around a year now and it has greatly improved my quality of life, I hate to hear that it might be doing damage to my heart.

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ayelold t1_jc7szg7 wrote

It's realistically decreasing your preload because of the positive pressure it generates, not necessarily a bad thing. The word "seems" is super suspect, makes me think they don't have enough data to actually have a finding on it. I'd wait for the followup study before passing it any mind.

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VenomOne t1_jc83njz wrote

It is a study on only 87 people, I reckon hence the vague phrasing.

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ayelold t1_jc84xbs wrote

Well, there's that. But also, it's talking about a compound we see rise in patients that are on ventilators. Both ventilators and CPAP machines are positive pressure devices, so seeing the body respond similarly isn't that surprising.

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williaty t1_jc8qhup wrote

As a fellow CPAP user that's really dug into the details on therapy, my instant suspicion is this: How well controlled are they looking at for "on CPAP therapy"? The clinical threshold for successful therapy is an AHI of 5 or below. However, there's LOTS of patient reports saying that getting from untreated down to an AHI of 5 didn't actually make them feel better. It's pretty common to see patient reports of symptom improvements in the AHI 1-2 range. So if the study is considering people treated/compliant/on therapy at AHI <=5 but the physiologically significant threshold is AHI <=1.5 or something, that's a LOT of people who are "treated" but not actually going to have better outcomes.

Additionally, it's sadly common for patients to start therapy successfully, both in the clinical sense of AHI<5 but also in terms of feeling better but then slowly drift out of the desired range as they gain weight, age, or have other life changes. Again, this could be producing a large cohort that's being counted as treated in the study but isn't getting the health benefits.

But yeah, this worries me too and I'd like to see more detailed investigation.

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Ian_Campbell t1_jc8sqeu wrote

I'm fully compliant, got my thyroid treated within range, and I'm still getting horrible sleep by how I feel during the day. No hormone panel results like low testosterone or low cortisol. Every day I'm tired in the morning and getting up is a longer process with the machine because waking up isn't enough, whereas when you wake up with no machine you're kind of ready to go.

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Ol_stinkler t1_jcarts7 wrote

If you don't mind me asking, what does your untreated AHI vs treated AHI and leak look like?

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Ian_Campbell t1_jcbttox wrote

I have no idea tbh I did a home sleep study before but I couldn't tell you any clue on how treatment changed it. I had moderate sleep apnea before.

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Ol_stinkler t1_jcc5vpa wrote

Moderate is anywhere from 15-29. May not be a bad idea to do another sleep test and see where you're sitting.

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Ian_Campbell t1_jcckub2 wrote

I would have to do another home test because I have trouble falling asleep before 6 am even with the meds. I think they based saying it was moderate on how far my blood oxygen fell but I'm sure they tracked the events too. It was enough to get the cpap machine but I have a quite low pressure they told me, around 5.5 whatever the units are, the mercury one I believe.

Since I have anxiety problems and have to use triazolam to even keep from not sleeping days and being totally incapacitated, it could be worth the diagnostics to see what they can do about making sure I get deep phase sleep.

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ZZ9ZA t1_jcsaoth wrote

I’d find that to be torture, personally. I find that any pressure below around 12 feels like it’s harder to breath than without wearing at all. It isn’t - it just feels that the flow doesn’t instantly adjust, so it kinda feels like you’re breathing through a straw.

(FWIW, on therapy for a bit over 7 years now, using an auto set pressure of 17-20. 20 is the highest my machine goes… actual peak pressure used most nights is around 19-19.2. AHI of <1 most nights, even “bad” nights are 1.5-2ish. I treated I was somewhere in the mid 50s, well into “severe”.

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Ian_Campbell t1_jcsdla7 wrote

I could try to manually set it and see if I feel better but since I'm fine, I figure there's some medical reason not to do more than necessary and my route is in following up with them. It's just hard to follow up with this stuff without extra money or energy, but at the same time letting 10 years go by half-abled without any help isn't acceptable. It's just hard to have hope when nothing helps, anxiety/depression med route total nope, stims don't help, cpap therapy didn't really help, thyroid replacement didn't really help.

It feels like the deeper you go trying to see specialists the more you are just stranding yourself for nothing.

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Charming_Length5294 t1_jc7ux8h wrote

Statins May Decrease Heart Disease For Everyone Because That's What Statins Are For

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Ol_stinkler t1_jc81uc9 wrote

This seems incredibly suspect, I'd be very curious to see what the apnea hypopnoea index (how we measure how many times on average people stop breathing in an hour) of these patients is.

I work at a DME that specializes in PAP. I spoke to a patient a few weeks ago who came to us after a recent diagnosis of arterial fibrillation. He'd been in a state of AFIB for 38 days. The night he set up his pap machine, he was able to fall/stay asleep. He woke up for the first time in 38 days without arterial fibrillation.

One of my favorite patients came to us with skyrocketing blood pressure, months into pap, he is off of his blood pressure medication for the first time in years.

PAP works, I've literally seen it happen before my eyes. No it's not fun, no it's not sexy, and there is no way you'll ever see a Hemsworth wearing one in a movie. But wear your PAP machine, it might just save your life.

Edit: This is from a study in 2014 that directly contradicts this article. "In OSA patients, 3 months of atorvastatin neither improved endothelial function nor reduced early signs of atherosclerosis although it lowered blood pressure and improved lipid profile. This trial is registered with NCT00669695." https://pubmed.ncbi.nlm.nih.gov/25221387/

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Woodofcourse t1_jc8z48f wrote

According to the research on statins it is known that they only add months to a person’s overall life. Am aware of 3 cases where statins (two were Crestor) were the cause of extremely severe body weakness, including one where patient had to be intubated. Find better ways to control cholesterol than these medications.

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According_Mistake_85 t1_jc80ekf wrote

Umm. They also said statins lower risk of cardiovascular events. Nope. Who funded this study?

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BroForceOne t1_jc9748p wrote

>“But CPAP also seems to have negative effects on the cardiovascular system. We need to investigate whether we should use more conservative airway pressures or other less-utilized treatments like oral appliances to treat patients with obstructive sleep apnea.”

Yes, it's been exhausting going from doctor to doctor to find one that doesn't just default to the brute force treatment method of CPAP and is actually willing to get inside that nose and throat and suggest alternative treatments based on individual physiology.

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HotMessMan t1_jcau98u wrote

You get jaw surgery, all other treatments have mediocre outcomes. Even jaw surgery is only like 60% effective but it’s the best one by far.

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AllanfromWales1 t1_jc6vir7 wrote

> Statins (a class of cholesterol-lowering drugs) may be one such method, according to the new study..

Does that mean that a CPAP using sleep apnoea sufferer who does not have raised cholesterol will not gain benefit from statins? (I've been on CPAP for 25 years+ now, but my cholesterol is not raised).

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dcheesi t1_jc7t8al wrote

I'm not sure if this study can answer that? It looks like the subjects were just apnea patients, not explicitly arranged into normal vs. high cholesterol groups(?), so it wouldn't necessarily answer the relative effectiveness between the two scenarios

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Lexam t1_jc8nv0j wrote

I take a statin and snore. So Yay for me!

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eatstoothpicks t1_jc7u8nl wrote

Wait. I thought statins were bad for you.

Can someone clear this up for me?

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SeductiveGodofThundr t1_jc88my0 wrote

I think you might be thinking of something else. Statins are a class of drug that reduces cholesterol. I think prolonged overuse can cause liver damage, but generally they’re probably life savers.

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