Body Changes Before And After The CPAP Machine
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Obstructive sleep apnea (OSA) is a common sleep disorder characterized by repeated collapse of the upper airway during sleep, leading to intermittent hypoxia and fragmented sleep. About 1 billion people worldwide suffer from OSA. The prevalence of OSA in the general population is 9% to 38%. However, due to the low awareness of OSA, its actual prevalence in the population may be much higher than this. OSA not only affects the patient’s sleep quality but is also closely related to the occurrence and development of a variety of chronic diseases, posing a serious threat to the patient’s physical and mental health.
CPAP therapy is often the most common treatment recommended for patients with sleep apnea. A CPAP machine delivers air to a mask that attaches to the nose or mouth and nose, and the continuous flow of air props up the collapsed airway to prevent it from becoming blocked.
CPAP therapy is considered safe and has been found to have many benefits, such as improved sleep, reduced snoring, less daytime fatigue, and lower blood pressure. Patients who use a CPAP machine may want to understand how their body changes after using CPAP. We will take a closer look at how CPAP therapy affects various aspects of the body and health.
The Dangers Of OSA
Obesity is a high-risk factor for OSA. 60% to 90% of OSA patients are obese, and the prevalence of OSA in obese people is about 40%.
OSA is closely related to the occurrence and development of a variety of cardiovascular and metabolic diseases. The prevalence of OSA in patients with cardiovascular diseases such as hypertension, coronary heart disease, heart failure, and atrial fibrillation is 40% to 80%. About 60% of hospitalized patients with type 1 diabetes also suffer from OSA.
Common physical effects of OSA are as follows:
Stroke: The incidence of moderate to severe OSA in men is three times that of the general population. Stroke patients usually have varying degrees of OSA.
Hypertension: Sleep apnea is one of the causes of hypertension. OSA is the main cause of secondary hypertension.
Increased stress on the heart: coronary heart disease, heart disease
Arrhythmia: The incidence of atrial fibrillation is 4 times that of the general population.
Congestive heart failure: moderate OSA increases mortality. New patients should be screened for OSA.
Sudden death: People with OSA have a 30% higher risk of having a heart attack or dying prematurely.
Mood disorders: depression, anxiety, general fatigue, decreased concentration, low mood and bad temper, impaired judgment.
Daytime sleepiness: causes 60% of car accidents, decreased concentration or forgetfulness, reduced work efficiency, reduced alertness, and slower reaction time.
Type 2 diabetes: Insulin deficiency and uncontrolled blood sugar. 58% of patients with type 2 diabetes suffer from OSA.
Obesity: Due to the shortened sleep time and reduced quality, people are more willing to eat high-calorie foods. Obesity is the largest independent risk factor for OSA, and it is estimated that 90% of obese men and 50% of obese women have OSA. The prevalence of OSA increases with BMI. About 80% of OSA patients weigh 130% or more than their ideal weight.
Gastroesophageal reflux disease (GERD)
Sexual dysfunction: decreased libido, erectile dysfunction.
Nocturia: Frequent urination at night.
Study On The Therapeutic Effect Of PAP
The earliest report on CPAP treatment for obstructive sleep apnea was published in 1981. A working group of AASM systematically sorted out the research results published in 2018.
In the background, the working group mentioned that the prevalence of obstructive sleep apnea (OSA) in American adults is 26%, of which about 10% are moderate to severe patients, and the proven consequences include sleepiness, reduced quality of life, cardiovascular disease, and increased accident rate.
So, can PAP therapy treat or eliminate this disorder and its consequences?
Using the PICO method, the working group searched the existing literature and evaluated each one based on relevance, quality of evidence, and level. Among the retrieved articles, a total of 184 were suitable for meta-analysis.
The following conclusions were drawn from the analysis:
- PAP therapy is effective in treating obstructive sleep apnea, reducing the apnea-hypopnea index (AHI) to an average of 4 events per hour.
- PAP treatment reduced subjective sleepiness by an average of 2.4 points on the ESS sleepiness scale. Patients who had above-average fatigue before PAP treatment experienced greater benefits from treatment. Patients with sleep apnea but no fatigue experienced no benefit in terms of sleep.
- PAP therapy improves sleep-related quality of life.
- PAP therapy can reduce nighttime blood pressure by an average of 2–4 mmHg. There are indications that the improvement depends largely on the patient’s initial blood pressure and AHI levels and PAP therapy compliance.
- PAP therapy may reduce the risk of death from cardiovascular events. However, studies have shown mixed results on this issue. Supportive evidence remains low to moderate. Similar findings were found for neurocognitive and psychological disorders (such as anxiety and depression), accident risk, LVEF cutoffs, and number of hospitalizations.
- One of the biggest challenges is patient motivation to use this therapy in the absence of daytime sleepiness. Providing more attentive patient care through traditional means or telemedicine could improve treatment adherence to average levels.
- To date, all alternative treatments have less supporting evidence than PAP therapy.
Body Changes After CPAP Treatment
Improves Concentration And Alertness
According to the findings of Ina Djonlagic et al., after one night of CPAP use, there was a significant improvement in subjective experience and attention and alertness. Some patients may need to use CPAP for a longer period to have an effect. Among OSA patients, only those who received CPAP had a faster PVT reaction time in the morning. They also felt more rested subjectively and reported better sleep quality compared to untreated OSA patients.
Improve symptoms of anxiety and depression
In a study on the effects of CPAP on anxiety, depression, and major cardiovascular and cerebrovascular events by Ming Chung Lee et al., it was found that CPAP can improve anxiety and depression in OSA patients, regardless of whether they have coronary artery disease (CAD). Although experts are still unsure about the specific effects of OSA on anxiety and depression, some believe that the low oxygen levels associated with OSA may cause changes in the brain that affect mood.
Improved cardiovascular health
CPAP can prevent MACCEs (major adverse cardiovascular and cerebrovascular events) in OSA. According to the study, using CPAP for at least 4 hours a day on top of usual care can reduce MACCEs in OSA patients, especially in terms of cerebrovascular events and stroke, compared with usual care alone.
The most critical point of this study is that even if patients insist on using ventilator treatment every day (at least 4 hours), the protective effect on cerebrovascular and cardiac is not the same. Sleep apnea is more harmful to cerebral blood vessels and stroke than to cardiac blood vessels. There are several main reasons for the body’s operation.
The blood vessels in the brain are relatively more fragile. When apnea occurs, the blood pressure fluctuates, and the lack of oxygen and accumulation of carbon dioxide will directly impact the blood vessels in the brain. However, the blood vessels in the heart are naturally protected, and the heart mainly supplies blood when the heart is relaxed, thus avoiding the impact of drastic fluctuations in blood pressure. The vibration during snoring plus apnea itself will accelerate the hardening of the carotid arteries.
It is worth noting that many strokes occur during sleep at night, and apnea may be the driving force behind them. Taking these factors into consideration, using CPAP to treat OSA has a significant effect on protecting brain blood vessels and preventing stroke.
Lowers blood pressure
There is a significant correlation between OSA and hypertension. About 30% to 50% of hypertensive patients have OSA, while the incidence of OSA in RH (resistant hypertension) patients is as high as 71% to 83%. Compared with non-RH (resistant hypertension) patients, the RH (resistant hypertension) group also showed an increased proportion of moderate to severe OSA.
CPAP is the first choice for patients with moderate to severe OSA. Logan et al. first pointed out that CPAP treatment can significantly reduce the 24-hour systolic and 24-hour diastolic blood pressure in patients with OSA and RH, especially at night.
An RCT study involving 125 patients with RH and OSA also explored the effect of CPAP therapy on arterial elasticity. The results showed that although CPAP therapy could not effectively reduce aortic stiffness, it could slow the progression of arteriosclerosis.
Regarding the long-term efficacy of CPAP treatment for OSA patients with RH, Navarro-Soriano et al. conducted a long-term follow-up (more than 4 years) of 161 patients in the HIPARCO cohort, indicating that long-term CPAP treatment with good compliance can significantly reduce blood pressure levels, reduce the average number of antihypertensive drugs, and help restore the circadian rhythm of blood pressure. Pleava et al. conducted a follow-up (average of about 51 months) on RH patients with OSA who received CPAP treatment, and the results also confirmed that long-term CPAP treatment was associated with abdominal circumference, weight loss, and improved heart rate.
Reduce the risk of heart failure
Due to the constant stress and lack of oxygen supply caused by OSA, the heart may gradually lose its ability to pump blood, leading to heart failure. In addition, the pauses in breathing at night may also cause the heart to work too hard, which can accelerate the decline of heart function.
For patients who already have cardiovascular disease, OSA may exacerbate their condition. Fortunately, treating OSA can not only reduce the risk of arrhythmias associated with it but can also improve other cardiovascular problems. By using treatments such as CPAP, patients’ oxygen supply can be significantly improved, and the hyperactivity of the sympathetic nervous system can be reduced, thereby improving cardiovascular health.
Improve diabetes complications
Research remains controversial regarding the potential for improved glycemic control using CPAP to treat obstructive sleep apnea (OSA).
In patients with obstructive sleep apnea (OSA) and inadequately controlled type 2 diabetes, continuous positive airway pressure (CPAP) for 6 months led to improvements in blood sugar and insulin resistance, according to a study by Elisabet Martínez-Cerón and colleagues in Madrid.
However, in another study, Melbourne-based researcher Jonathan E Shaw and colleagues found that CPAP had no beneficial effects on blood sugar in patients with relatively well-controlled type 2 diabetes, despite improvements in diastolic blood pressure, daytime sleepiness, and quality of life.
However, studies have shown that CPAP can improve these complications in people with diabetes. Some people with diabetes develop vision problems, such as color blindness or macular edema. Treatment with CPAP can improve these problems.
Improve male reproductive problems
Li et al. systematically reviewed 28 studies, including randomized controlled trials and observational studies. The results showed that CPAP not only improved the international erectile function score of OSA patients’ subjective evaluation but also improved the scores of objective indicators such as the total number of erections and nocturnal penile hardness.
Although CPAP is not as good as phosphodiesterase type 5 inhibitors (PDE5i) in improving erectile function scores and sexual intercourse satisfaction scores, CPAP is even more effective in increasing the total number of erections, and CPAP combined with PDE5i is more effective in improving ED-related evaluation indicators. Studies have found that the use of PDE5i alone has an adverse effect on sleep breathing data and heart rate variability in patients with severe OSA, and CPAP combined with PDE5i ensures a therapeutic effect on OSA patients.
OSA can affect male reproductive function in different ways, such as OSA is associated with low testosterone levels in men, OSA is an independent risk factor for ED, OSA can lead to reduced semen quality, and OSA patients have an increased risk of infertility. Given that OSA is a reversible factor affecting male reproductive function, it is crucial to actively treat OSA men who want to have children (such as CPAP).
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