Varicose Veins -- Caused by CPAP, BIPAP, ASV?

[VisitorX]

I developed varicose veins in my legs during the past 6 years, a time that coincided with my use of CPAP and APAP. These vein problem seem to have gotten worse during recent months, when I've been using ASV. I'm wondering if there is a connection, and whether others have experienced or thought about this.

The mechanism would be this--

For CPAP and APAP, which are devices with constant pressure across the respiratory cycle (pressure inspiration = pressure expiration), there is a constant increase of pressure in the chest, which impedes venous return (the return flow of venous blood to the heart), leading to a build up of pressure in the peripheral veins. 

For BIPAP and ASV, the problem with venous return would be intensified because, normally (that is, with no PAP, as well as with CPAP or APAP) pressure is lowest in the chest during inspiration, which facilitates venous return; thus inspiration would be the time when most blood returns to the heart. Yet with BiPAP and ASV, pressure is highest during inspiration, a reversal of normal. So the part of the respiratory cycle that is normally best for venous return becomes the worst. 

In fact, I would expect that the onset of inspiratory pressure, which occurs 10-20 times per minute, would send a retrograde pressure wave down the peripheral veins, hitting the valves in the veins and even more directly causing damage due to continually repeated small pressure waves. I would expect that this sequence would first break down the one-way valves in the larger veins, which are most directly affected by the pressure waves. As those valves became incontinent, allowing the pressure wave to propagate further down into the venous "tree," you would expect damage to occur in increasingly small veins. I believe this is more or less what I have experienced during the time I have been on ASV.

I also wonder whether this same mechanism (a hinderance of venous return) might play a role in the problems that have been seen with ASV in patients with heart failure.

I searched "Varicose Veins AND CPAP" and "Varicose Veins AND sleep apnea" at PubMed and nothing came up.

Has anyone experienced worsening varicose veins that they associate with PAP and especially BIPAP /ASV use? Does anyone have thoughts about this?--as well as the possible relationship between impaired venous return and dangers in using ASV in heart failure patients?

[Sleeprider]

Varicose vein development is more associated with growing older than with CPAP therapy. I can think of no mechanism where CPAP would be a potential contributor to the condition. As you probably know the risk factors in order are age, sex, pregnancy, family history, obesity and a need to stand for long periods of times. There seems to be a tendency for CPAP to be blamed for other conditions that arise while using it, but in this case, and most others, there is no relationship.

[VisitorX]

Sleeprider, with due respect, I described in my post a mechanism by which CPAP/APAP and especially BIPAP/ASV could, in theory, cause or contribute to varicose veins. I am trying to determine if this theoretical mechanism actually plays out in practice. I understand that it is difficult and sometimes impossible to determine causation, and that sometimes people misattribute causation and, in this case, blame PAP therapy for things that have nothing to do with it. Still, one good way to start to assess this question is to ask whether others have experienced similar things.

[ardenum]

If what you theoretize, would turn out to be remotely true, the question is, would you stop the therapy? If not then the truth in this case is inconsequential.

[Aludj]

Varicose vein development is more associated with growing older than with CPAP therapy.  I can think of no mechanism where CPAP would be a potential contributor to the condition.  As you probably know the risk factors in order are age, sex, pregnancy, family history, obesity and a need to stand for long periods of times.  There seems to be a tendency for CPAP to be blamed for other conditions that arise while using it, but in this case, and most others, there is no relationship.

While I tend to agree with you, there might be some relation between the varicose vein and sleep apnea. Six years ego, there was a study for the relation between pressure socks and their impact to sleep apnea:

https://www.sciencedirect.com/science/ar...5714004948

Result n a nutshell, compression stockings may ease sleep apnea.

If it does, would it be possible that that treating sleep apnea with CPAP may impact the varicose veins? Maybe this impact is more noticeable by people with the risk factor(s) you've listed.

I've also started to develop varicose veins as well, but only on my right leg. I've chalked mine up to aging and other risk factors and still didn't change my mind...

[Sleeprider]

I don't argue that obstructive sleep apnea does not share comorbidity with varicose vein risk. I do reject the notion of a "pressure wave" coming from fractions of a PSI traveling through the body and affecting the veins.

[Gideon]

A correction SR, SMALL fractions of a PSI

[OpalRose]

VisitorX,
I don't discount your theory at all.  I believe your are talking about a condition called Venous Insufficiency, and if Cpap use could cause or aggravate this condition.  You may or may not have "visible" veins in your legs to have this condition.  

It's extremely hard to find information on this subject and if a link between this condition and Cpap use exists.

https://pubmed.ncbi.nlm.nih.gov/10607172/

I suffer with Venous Insufficiency (This is where valves in some veins are damaged and impedes blood flow back to the heart).  This in turn causes leg and ankle swelling, sometimes bruising.  What causes the damage to these valves is the question.

Coincidence or not, I started to notice this problem about 6 months after starting Cpap about 6 years ago.  I never associated a connection to Cpap use until recently.

My Pulmonologist/sleep specialist seemed to acknowledge a possible connection, but wouldn't or couldn't confirm.  
So earlier this year, he suggested I try a Bipap as the effect may be different than Cpap/Apap.

So far, after using a BiPap for 6 months, there is no effect one way or the other on the venous insufficiency problem.

I've tried searching for literature on any connection between pap use and venous insufficiency, but there is little out there.  I found a couple articles, but they fall short of pinpointing any real connection.  Little is known about this and it seems that doctors dismiss any connection to Cpap.  

Believe me, I'm not blaming Cpap use for this problem and would never stop using it.  But a small part of me has to question a connection.

Abstract

Effects of CPAP on Venous Return

Continuous positive airway pressure, like positive end-expiratory pressure (PEEP), increases lung volume and pleural pressure and usually decreases venous return. The decrease in venous return has been ascribed to a simple increase in right atrial pressure. However, recent studies have demonstrated PEEP also changes the resistive and elastic properties of peripheral veins. PEEP elevates the upstream pressure driving venous return, increases venous resistance, and directly compresses the inferior vena cava. The dogma that PEEP decreases venous return by decreasing the pressure gradient driving blood from the systemic vessels to the heart appears to be untrue.

https://pubmed.ncbi.nlm.nih.gov/10607172/

[SarcasticDave94]

I have a ResMed ASV and a heart condition called Premature Ventricular Contractions or PVCs. I have also had leg/foot swelling with circulatory inefficiencies. Include all the other medical ailments that I've got, with multiple back issues and COPD. Yet none of these point back to the ASV causing negative effects, only positive ones as far as the gaggle of docs are concerned.

[jaswilliams]

I have been using an ASV for two years I do not have Varicose veins