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CPAP better than APAP for cardiac issues?
#1
Hello. I have just been told by a new sleep doctor that constant pressure CPAP for obstructive sleep apnoea is better than auto-titrating APAP for cardiac health in general, and should definately be chosen in people who already have e.g. atrial fibrillation or high blood pressure, a history of a heart attack etc. My machine will do either.

Does anyone know anything about this? Any references to medical publications that come to this conclusion would be very welcome.

Thank you
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#2
(05-21-2015, 12:11 PM)Asjb Wrote: Hello. I have just been told by a new sleep doctor that constant pressure CPAP for obstructive sleep apnoea is better than auto-titrating APAP for cardiac health in general, and should definately be chosen in people who already have e.g. atrial fibrillation or high blood pressure, a history of a heart attack etc. My machine will do either.

Does anyone know anything about this? Any references to medical publications that come to this conclusion would be very welcome.

Thank you

I've never heard that. CPAP (auto or fixed) is supposed to improve/prevent afib,but I've never heard that a constant pressure was better than auto.

I'm not a doctor and don't play one on TV, but would expect that an auto machine that prevented an apnea during the night would be better for your afib than a fixed pressure machine that just let the apnea happen.

Maybe someone else has heard something.
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#3
(05-21-2015, 12:11 PM)Asjb Wrote: Hello. I have just been told by a new sleep doctor that constant pressure CPAP for obstructive sleep apnoea is better than auto-titrating APAP for cardiac health in general, and should definately be chosen in people who already have e.g. atrial fibrillation or high blood pressure, a history of a heart attack etc. My machine will do either.

Does anyone know anything about this? Any references to medical publications that come to this conclusion would be very welcome.

Thank you

Edited - sorry, cat stepped on keyboard before I was done.
Here's some reference. I am foggy today, but these conclusions don't seem to match your doctor.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3351715/
http://www.ncbi.nlm.nih.gov/pubmed/21529314

By the way, have you asked the doctor for the references on this to help you make your decision? The docs often have information more recent than you can find on the internet. Keep in mind that while he is a doctor, his area is sleep, not cardiology.
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#4
It seems like a lot of sleep docs like to put their patients on cookie cutter regimens. That way they don't have to think too hard.

So is there some evidence somewhere that justifies a conclusion like this? (using cpap rather than apap) Probably. Seems like there's evidence to support just about any theory you want to put out there. But I'll stick with my nice tightly controlled range that allows me to sleep in whatever position I want and adjusts the therapy accordingly.
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#5
(05-21-2015, 12:11 PM)Asjb Wrote: Hello. I have just been told by a new sleep doctor that constant pressure CPAP for obstructive sleep apnoea is better than auto-titrating APAP for cardiac health in general, and should definately be chosen in people who already have e.g. atrial fibrillation or high blood pressure, a history of a heart attack etc. My machine will do either.

Does anyone know anything about this? Any references to medical publications that come to this conclusion would be very welcome.

Thank you

Ask the doc to write it down and sign it. I will wager the doc will not put his/her name to that statement.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#6
Or just ask for a reference to the study that found A-fib patients do better on CPAP than APAP, or even BiPAP and BPAP ASV. Many heart patients have complex apnea that are not treated effectively by CPAP.

I'd call B.S. Would that be rude considering it is?
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#7
(05-21-2015, 01:13 PM)Mosquitobait Wrote:
(05-21-2015, 12:11 PM)Asjb Wrote: Hello. I have just been told by a new sleep doctor that constant pressure CPAP for obstructive sleep apnoea is better than auto-titrating APAP for cardiac health in general, and should definately be chosen in people who already have e.g. atrial fibrillation or high blood pressure, a history of a heart attack etc. My machine will do either.

Does anyone know anything about this? Any references to medical publications that come to this conclusion would be very welcome.

Thank you

Edited - sorry, cat stepped on keyboard before I was done.
Here's some reference. I am foggy today, but these conclusions don't seem to match your doctor.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3351715/
http://www.ncbi.nlm.nih.gov/pubmed/21529314

By the way, have you asked the doctor for the references on this to help you make your decision? The docs often have information more recent than you can find on the internet. Keep in mind that while he is a doctor, his area is sleep, not cardiology.

Those 2 links were very interesting but they do not bear at all on cardiac health except for blood pressure. According to these 2 studies both APAP and CPAP reduce BP somewhat but there is no statistically significant difference between the two. The BP finding might be considered a contributing factor to heart health.

Asjb,
I would be very interested in your new sleep doc's reference for that statement, if he/she would be willing to tell you.

Best Regards,

PaytonA
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#8
It isn't always accurate that doctors have information before we do. When our child was in the hospital, we were kept informed of all medication that was prescribed, changed, etc. We watched that and also caught a doc prescribing a new medication that interacted with other medication that had previously been prescribed and still being taken. At any rate, there was a notification (this is a separate incident) that we received that one of her medications was having issues with safety and with how it interacted with other medications. So, the prescribing doc was notified and said that sometimes the docs are the last to know. I attribute some of that to how busy they are trying to save patients' lives that they don't read some of the notifications they receive in a timely manner. In this case, the doc had not received a notification and although we had outside careers as well as a business of our own, we had time to keep up with these things but we did this for one person and docs have to keep up with many.

As far as your post goes, it doesn't make sound sense to me but, I am not a doctor and I would think having lower pressure during the night would be easier on the heart and other organs than having a constant pressure all night long. Just my thoughts.

I don't know why this is, but, my former sleep doc and the current sleep doc as well as the RT tried their best to get me to agree to be on a fixed pressure after I insisted that I would not accept less than an auto. So, to prove my point, for one week I put the machine on a fixed pressure and there was no difference to the better so I put it back the way it was and it has been there since. My AHI numbers nightly are great and I rarely get over 1 so it must be working great.
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#9
(05-21-2015, 12:11 PM)Asjb Wrote: Hello. I have just been told by a new sleep doctor that constant pressure CPAP for obstructive sleep apnoea is better than auto-titrating APAP for cardiac health in general, and should definately be chosen in people who already have e.g. atrial fibrillation or high blood pressure, a history of a heart attack etc. My machine will do either.

Does anyone know anything about this? Any references to medical publications that come to this conclusion would be very welcome.

Thank you
From: Central Sleep Apnea Detection and the Enhanced AutoSet Algorithm
http://www.resmed.com/fr/assets/document...-paper.pdf

Introduction: page 1
... It is for this reason that APAP devices are generally not recommended for patients known to have conditions, such as congestive heart failure, that predispose to central apneas
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#10
(05-21-2015, 09:07 PM)zonk Wrote: From: Central Sleep Apnea Detection and the Enhanced AutoSet Algorithm
http://www.resmed.com/fr/assets/document...-paper.pdf

Introduction: page 1
... It is for this reason that APAP devices are generally not recommended for patients known to have conditions, such as congestive heart failure, that predispose to central apneas

That's warning about the possibility of "runaway" pressure on machines without central apnea detection. If an APAP machine doesn't detect central apnea, it might tend to increase pressure when there is pressure induced central apnea, and make central apnea even worse.

It appears to be discussing the problems of APAP before central detection and is touting the advantages of the S9 machine with FOT central apnea detection.

This shouldn't be a problem with a modern APAP machine properly used. Even with an older APAP, you could still use it with a limited upper pressure range. In the simplest usage, you could set the APAP to have the maximum pressure you'd use a manual CPAP at and there is no concern about increased pressure induced centrals.

If the doctor has even minimal CPAP knowledge, he could use a higher maximum APAP pressure range and monitor the results for increased central apnea. Even if the machine doesn't correctly detect central apnea, it will still detect increased apnea. If it's fully data capable, you can tell that the AHI or CAI goes up at higher pressure and make appropriate adjustments.

There's an inexcusable bias and lack of knowledge about APAP and even CPAP machines in the medical community. Many doctors seem to think the only way to use an APAP machine is wide open 4-20 auto pressure range, which is usually the wrong way to use it. They also are unaware of or willfully ignore the very valuable data collected by modern CPAP machines.

I suspect you may be right about why OP's doctor thinks APAP is not OK for heart patients. OP's doctor may simply be a fossil who doesn't understand how a modern APAP works, or how it can be limited in pressure.
Get the free SleepyHead software here.
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If it's midnight and a DME tells you it's dark outside, go and check it yourself.
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