Friday, March 29, 2013

Withdrawal of CPAP for two days in patients with obstructive sleep apnea

In patients with obstructive sleep apnea (OSA), no matter the severity, I tell them to use their CPAP every time they sleep. This provides the best results of their therapy. Of course, not everyone can or will use it EVERY night. I explain that the CPAP is not curing their OSA. However, using CPAP nightly for weeks or months on end can mildly reduce the severity, especially if they already have severe OSA. Here is a study demonstrating just that effect. They studied patients initially in the lab to make the diagnosis. Then they used the CPAP continuously for 4 months on average. Then they went two nights without the CPAP and had repeat sleep studies. The results showed that for those with mild to moderate OSA, there was no difference in OSA severity, objective sleepiness, subjective sleepiness, or sleep architecture when off the CPAP. However, in the ones with severe OSA, there was a mild improvement in OSA severity - but they still had severe OSA! But subjective and objective sleepiness levels were no different. The authors think (and I agree) that treating severe OSA for a few months may reduce inflammation in the upper airway enough to mildly reduce the OSA severity. But, because they still have severe OSA, they continue to feel sleepy when not using their CPAP. So use your CPAP every time you sleep if you want to feel as good as you can.

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