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Question about effects of long term cpap use

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Question about effects of long term cpap use

Postby Guest » Tue Jan 22, 2008 9:02 pm

I was reading Breathless Pete's post, and he asked a question that has been on my mind since I was diagnosed a month or so ago. I asked my doctor, but he gave a vague, non-committal answer. Here's the question:

Have any studies been conducted that looked at the effects of long term cpap use on the severity of a person's apnea?

I ask because it seems possible to a layman that cpap could create a long-term dependency and, after all, we're all hoping for a technological breakthrough some day, right?

My AHI is only 12, and I suspect that I'm a pretty good candidate for an oral devcie (I have a funky overbite and a wimpy chin), and this seems like a question I should get answered in order to make an informed decision about how best to treat this condition.
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Postby Bearded One » Tue Jan 22, 2008 9:22 pm

I have been on CPAP for over 13 years and I very much doubt that it has caused any permanent changes to the physiology of my airway. The air pressure is titrated to be just enough to form a pneumatic stent, it is not sufficient to cause any stretching or distortion of the structures.
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Postby Guest » Tue Jan 22, 2008 10:04 pm

I very much appreciate your response. There seems to be a wide variety of opinions on the possible side effects, both short and long term, of cpap use. The anecdotal stuff is all over the place, as one can see simply from looking over this board. Are there any studies that have looked at the long term effects of cpap use?

It's pretty clear that it can have all kinds of side effects- from vertigo to sinus irritation to flatulance. Surely cpap has been around long enough for someone to look at possible correlations between its use and things like ear infections and increases in AHI.

You and Daniel seem to be the authorities on peer reviewed studies. Ever seen anything along these lines?
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Postby Bearded One » Tue Jan 22, 2008 10:56 pm

I haven't seen anything about the long term effects of CPAP. Most of the effects that I have been reading about on here that are caused by CPAP are transient, and the effects disappear soon after stopping CPAP. Aerophagia is simply the ingestion of air. Skin irritations from the mask can usually be mitigated or eliminated. Some of the side effects, such as GERD is related to sleep apnea, it is not a side effect of CPAP. Some of the anecdotal side effects of CPAP, such as ear infections, may be a side effect of CPAP, but it may also not be caused by CPAP.

I just read a post by PuhJommies who was told that her ear pain may be referred pain from GERD; this would mean that her ear pain was caused by sleep apnea, not CPAP.
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Postby Guest » Wed Jan 23, 2008 1:03 am

To Original Poster,

It's a good question. I can understand your question and underlying concern. (I will admit that I am hoping that someone else will be able to post some studies to better answer your specific question, because I am too tired to go over to pubmed.gov and search around tonight).

I do not want to minimize the difficulties that people experience, but do want make some comments:

a) It can be difficult to determine the cause of ‘side-effects’, because there are so many conditions are associated with sleep apnea. For examples:
GERD & Acid reflux: people with this often have the problem with air-in-stomach, gas, bloating.
Sinus issues – well many people experience sinus issues without PAP.
Cold/Flu – People will post to say that they got a cold/flu from PAP. But, was it the PAP, or perhaps they were exposed to a virus in the grocery store or doc’s office.

b) PAP treatments have improved over the past few years. Everyone uses the acronym CPAP, but there is auto-PAP, bi-PAP, ASV-PAP which work better for patients depending upon the specific case. There has also been the introduction of features/accesories (exhalation relief, built-in humidifiers, ramp, data-capability, hose covers, heated hoses) that help with various issues. You would be amazed at the number of people (and medical professionals!) who are unaware that these are available.

Some comments regarding your specific situation, PAP versus dental appliance:
Based on 'a' above, consider if you have any associated conditions or issues that might play a role in either option.

You could ask your doc about prescribing a trial (weeks, months) of PAP to see how you do with it. Insurance often ‘rents’ PAP by the month on behalf of the patient. I have seen hunerous reports of this being done for patients..

IMO, a key advantage of PAP over dental applicane is data-capability. This allows for monitoriing of the effectiveness (AHI data) of the treatment. The data can be viewed daily, and a good sleep doc can review downloaded reports. Sleep apnea is beleived to gradually worsen with age, weight gain, so it's good to have that monitoring over the years. Also, even a mild condition is associated with higher risks of associated conditions, so some people want to monitor that they are fully treated (~ AHI < 5) verus "I feel better".

Good luck to you.
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Postby Daniel » Wed Jan 23, 2008 5:05 am

Anonymous wrote:I very much appreciate your response. There seems to be a wide variety of opinions on the possible side effects, both short and long term, of cpap use. The anecdotal stuff is all over the place, as one can see simply from looking over this board. Are there any studies that have looked at the long term effects of cpap use?

It's pretty clear that it can have all kinds of side effects- from vertigo to sinus irritation to flatulance. Surely cpap has been around long enough for someone to look at possible correlations between its use and things like ear infections and increases in AHI.

You and Daniel seem to be the authorities on peer reviewed studies. Ever seen anything along these lines?



From time to time there are some small studies on long term use of cpap. Nothing major (numbers wise), so I usually pass them bye.
Without being specific they usually indicate that there are no problems with long term use of cpap, as it merely splints the airway open, rather than force people to breathe. It's effects are not mechanical (like a stent) so there should be no damage to the physiology of the patient.

The National Institute for Health & Clinical Excellence are due to release a paper on cpap effectiveness this month. I have pasted a link to the final appraisal determination document, which, while not covering your exact question does make interesting reading. This guideline will determine the NHS (National Health Service, UK) position until at least 2010.

http://www.nice.org.uk/nicemedia/pdf/CP ... tation.pdf

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Postby Bearded One » Wed Jan 23, 2008 6:10 pm

Interesting report, thank you. I found this part to be especially interesting:

"The Committee considered the alternative treatment options
available for people with OSAHS, namely lifestyle advice, dental
devices and surgery. The Committee heard that advice to lose
weight is often not effective, partly because people with severe
OSAHS lack the energy to engage in weight loss activities. The
experts stated that dental devices can be uncomfortable and of
limited effectiveness for most people, even those with mild OSAHS.
The Committee also discussed the use of surgical procedures to
correct craniofacial features associated with OSAHS, and
understood that such forms of surgery were not usually considered
to be viable treatment options because of lack of efficacy."
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Postby Guest » Fri Jan 25, 2008 8:52 pm

My doctor specializes in sleep disorders and I believe his title it "Sleep Specialist". When I asked him about the effects of long term CPAP usage, he told me of the studies done it was determined it does no damage to the person.

I would imagine that pertains to people that don't have some other physical problems besides OSA.

I was concerned with this also but he did not seem to be at all.

For me if there was to be a problem with long term usage I will still use the CPAP because I remember what life was like before CPAP and I don't want to go back there again....
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Husband on Cpap @ 20 years

Postby Dianne » Sat Jan 26, 2008 11:39 am

My husband has been a Cpap user for about 20 years. He also has several friends on Cpap, following his advice.

Considering the alternative, I think that IF there were any ill effects they are minimal compared to the very LIFE threatening problems that would occur if they had not used Cpaps.

If I were to make a wild guess, I would say that his upper jaw has receded slightly from the tight fit he prefers from his mask. In the morning, I can occasionally see mask marks on his face, and realize he has tightened the mask for a close fit. He has no other ill effects from Cpap, nor have his friends. If they hadn't gone for a Cpap sleep lab test about 20 years ago, I suspect some of them would be dead now.

Given the alternatives to Cpap use, death, can the use seem so harmful?
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