Sleep Apnea returns rapidly when CPAP stopped

[zonk]

As I,m recovering from deviated septum and turbinate surgery and not used cpap for the last 5 days and probably wont be using for few more days it feel that my apnea is coming back. Just wanted to share this article with you might gives some positive reinforcement especially for newbies and those struggling to stay on therapy.
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From MedPage Today
By Charles Bankhead, Staff Writer, MedPage Today
Published: August 13, 2011
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco.

Obstructive sleep apnea (OSA) and its associated complications recurred rapidly after discontinuation of continuous positive airway pressure (CPAP), results of a small randomized trial showed.

After two weeks without CPAP, the number of arousal events per hour had more than tripled, and apnea-hypopnea events had increased 17-fold. Both measures remained unchanged in patients who continued CPAP.

OSA returned within days after stopping CPAP, as did subjective sleepiness, but objective measures of sleepiness did not change significantly.

By the end of the study, endothelial function had decreased significantly, and morning blood pressure, heart rate, and urinary catecholamines all increased significantly compared with patients who remained on CPAP.

"We found that CPAP withdrawal was associated with a return of OSA by the first night," Malcolm Kohler, MD, of University Hospital Zurich in Switzerland, and coauthors reported online in the American Journal of Respiratory and Critical Care Medicine.

The principal implications of the findings relate to clinical research in OSA, including studies of the physiologic effects of OSA and response to novel therapies, the authors added. The effect of CPAP withdrawal on sleep-disordered breathing and cardiovascular risk factors requires further study.

The effects of CPAP withdrawal on patients with diagnosed OSA previously have been evaluated only in uncontrolled trials, limiting the ability to draw definitive conclusions. The authors sought to clarify the effects in a randomized, controlled trial to examine a two-week trial of CPAP discontinuation.

Investigators queried a database of patients with OSA treated with CPAP and a sleep disorders center. Eligible adult patients had an oxygen desaturation index (ODI) >10/h in their initial sleep study and after four nights without CPAP, had used CPAP for more than 12 months, and had an average compliance of at least four hours per night.

After enrollment, all patients resumed CPAP for at least seven days and then were randomized to continue CPAP or switch to subtherapeutic CPAP for two weeks.

Investigators assessed patients' pulse oximetry nightly throughout the study period. Subjective sleepiness was evaluated at baseline and two weeks by means of the Epworth sleepiness score, and objective sleepiness was determined by a sleep resistance challenge at baseline and two weeks.

Patients completed a simulated driving test and a reaction-time task at baseline and two weeks to assess psychomotor performance at baseline and after two weeks.

Flow-mediated dilation was measured by ultrasound to assess endothelial function. Blood pressure and heart rate were measured three times daily through the study. Blood samples obtained at baseline and after two weeks were used to measure markers of systemic inflammation, insulin resistance, and lipids.

Patients provided 12-hour urine specimens at baseline and after two weeks for assessment of urinary catecholamines.

Investigators randomized 41 patients, 40 of whom completed the study. One patient in the subtherapeutic group dropped out after four days because of intolerable daytime symptoms.

Baseline characteristics, including sleep characteristics, did not differ significantly between groups.

When the study ended, patients in the subtherapeutic group had significant changes in multiple parameters compared with patients on continuous CPAP, including:

•Average arousal incidents - +20.7/h versus -0.6/h, P<0.001
•Apnea-hypopnea events - +33.8/h versus 0.4/h, P<0.001
•ODI events - +26.3/h versus -0.2, P<0.001
•Epworth score - +2.0 versus -0.7, P=0.001
•Morning blood pressure - +6.2/+4.4 versus -2.3/-2.5 mmHg, P=0.016, P=0.008
•Morning heart rate - +6.3 versus 0.0 bpm, P=0.035
•Flow-mediated dilation - -3.2% versus -1.7%, P<0.001
•Norepinephrine - +11.5 versus +0.9 nmol/mmol, P=0.012

Psychomotor performance did not change significantly in response to CPAP withdrawal, nor did markers of systemic inflammation, insulin resistance, or cholesterol.

The study was supported by the Swiss National Science Foundation and the Swiss Society of Pneumology.
http://www.medpagetoday.com/Pulmonology/...erid=53898

[zonk]

Sleep Apnea Makes Quick Comeback When Breathing Treatment Stops
by Patti Neighmond
SHOTS - NPR Health Blog

If you use a breathing machine to treat your sleep apnea, it's probably a bit clunky. But it's also probably doing you a lot of good.

In a small study, researchers at the University Hospital in Zurich, Switzerland report that when patients stopped using continuous positive airway pressure machines, or CPAP, for one night or more, not only were they sleepy the next day, but a flood of related health problems returned.

The findings appear online in the American Thoracic Society's American Journal of Respiratory and Critical Care Medicine.

Those findings make a lot of sense, says Dr. Nancy Collop, medical director of the Emory Sleep Center in Atlanta. She likens the CPAP machine to blood pressure medication. If you stop taking your medication, your blood pressure rises. If you forget to use your CPAP, your sleep apnea will return.

Patients with sleep apnea can awake hundreds of times during a night, gasping for breath and never really getting a good night sleep. The breathing machine helps patients by pumping air directly into their obstructed airway, essentially forcing them to breathe regularly.

What was surprising in the study was just how quickly problems returned when patients went off the machine. Researchers divided patients into two groups. One used their breathing machines as usual. The other was taken off their regular machine and given another one that pumped less air, making it ineffective. After two weeks, the group on the ineffective breathing machine experienced a return of a number of health problems related to apnea.

Researchers found a marked increase in blood pressure and heart rate, as well as increased dysfunction of blood vessels inside the heart and certain hormones related to heart disease. CPAP withdrawal leads to a return of obstructive sleep apnea within the first night off CPAP, researchers say.

Dr. Collop says that because the CPAP machine can be cumbersome, most patients at one time or another will ask her if they really need to wear it every night. But over the years, the machine — which was once the size of a suitcase — has been re-designed and is now about the size of a square box of tissue.

Even so, "CPAP is a treatment, not a cure," she says. "Unless it's on your nose or over your face, it's not going to be helping you when you're sleeping."

[Sleepster]

I hope you can get back on your CPAP soon, Zonk. If nothing else, this experience will remind you of all the benefits you derive from CPAP therapy.

[greatunclebill]

the thing i wouild like to know is how much these knot heads were paid to do a study on this. every person on a cpap knows that apnea is worse when you stop therapy, than when you were on therapy, except the ones that really believe they are going to be cured.

[Cutter]

Occasionally, my nostrils become too sore to use my mask with pillows. When that happens I have to do without my CPAP. I always have a hangover (headache & fuzzy head). I now have a backup nasal mask that I can switch to. Zonk, I hope you fully recover soon.

[bige94]

Mine dosent go away. I can tell a difference the first night with no cpap.

Good luck and get back on that machine.