Continuous positive airway pressure (CPAP) has long been the most widely prescribed treatment for obstructive sleep apnea (OSA), a life-threatening disorder that causes sufferers to repeatedly stop breathing during sleep.
OSA is thought to affect more than 25 million Americans, and it is accompanied by an increased risk for heart disease, heart attacks, high blood pressure and strokes among other health concerns. CPAP keeps the airway open by pumping continuous oxygen through a face mask worn during sleep. Conventional wisdom suggested, and limited research seemed to back up, that CPAP treatment would diminish those risks as the apnea episodes—the instances in which breathing halts—subsided. New research indicates that may not be the case.
The Heart of the Matter
The findings of the largest, randomized-controlled study of CPAP’s relationship with cardiovascular health imply that CPAP therapy does not prevent heart attacks, strokes, or other cardiovascular events. The results of the study were published recently in The New England Journal of Medicine.
The research focused on nearly 2,700 participants between the ages of 45 and 75 from seven different countries. All study subjects had moderate to severe obstructive sleep apnea and were diagnosed with coronary artery disease or cerebrovascular disease.
Participants were split between those who received CPAP treatment and those provided counseling on healthy sleep habits and lifestyle changes to minimize the effects of OSA. Researchers conducted follow-up visits with participants over a five-year span, and their findings surprised them.
CPAP: Not all Positives
The study confirmed that CPAP use reduced daytime drowsiness, and was accompanied by improvements in mood, productivity, and quality of life. But the research found no impact on heart attacks or strokes, or on hospitalizations or deaths related to cardiovascular problems, compared to the non-CPAP group.
One explanation is that the CPAP group participants were only able to wear their masks for about three hours per night, a span consistent with real-world CPAP users. That may not be enough time to affect the severity or frequency of cardiac events associated with OSA.
According to a Washington Post report on the study, the physiological changes that accompany removing the mask during sleep—another typical obstacle faced by OSA sufferers—may also return the body to its cycle of apnea episodes. Further research is needed to determine whether better adherence to CPAP may yield heart-related benefits, and more study is also necessary to distinguish the effects of CPAP on those who have existing cardiovascular problems versus those who don’t.
CPAP Not the Only Choice
It’s important to note that CPAP is not the only sleep apnea treatment available, and the study discussed here did not include CPAP alternatives such as oral appliances. These comfortable, custom-made devices fit similarly to sports mouthguards, and they are designed to hold the jaw in its proper position to promote an open airway during sleep.
Although CPAP therapy is not without benefits, the biggest obstacle to its effectiveness is noncompliance. Many who try CPAP find the air mask uncomfortable and discontinue use. Oral appliances are recommended for many sleep apnea sufferers, including those with moderate to severe sleep apnea who are unable to tolerate CPAP.
Denver sleep apnea dentist Dr. Kevin Berry is dedicated to helping those with sleep apnea restore healthy sleep. If you’re concerned about chronic snoring, recurring daytime fatigue or other indicators of sleep apnea, please call the TMJ Therapy & Sleep Center of Colorado today at (303) 691-0267.
