CPAP withdrawal: It may foster diabetes, heart disease, study says

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Friday, June 16, 2017

YARMOUTH, Maine – Not using CPAP therapy could have grave repercussions for patients with sleep apnea, according to a study published this month in the Journal of Clinical Endocrinology & Metabolism.

“OSA recurrence during CPAP withdrawal increases plasma free fatty acids (FFA) and glucose during sleep, associated with sympathetic and adrenocortical activation,” researchers concluded. “Recurring exposure to these metabolic changes may foster diabetes and cardiovascular disease.”

Researchers based their findings on a randomized crossover trail of CPAP vs. CPAP withdrawal. They used 31 patients with moderate to severe OSA acclimated to CPAP.

To conduct the study, patients underwent polysomnography while sleeping with CPAP or after CPAP withdrawal, in random order. Venous blood was sampled at about 20 minute intervals on both nights. In 11 patients, researchers assessed glucose kinetics with an infusion of 6,6-[2H2]glucose.

Researchers found CPAP withdrawal caused recurrence of OSA associated with hypoxemia, sleep disruption, and heart rate elevation. CPAP withdrawal dynamically increased nocturnal FFA (p = 0.007), glucose (p = 0.028), and cortisol (p = 0.037), in proportion to respiratory event frequency, heart rate elevation, or sleep fragmentation.

CPAP withdrawal also increased systolic blood pressure (p = 0.017) and augmentation index (p = 0.008), but did not affect insulin, triglycerides, glucose production, oral glucose tolerance, cholesterol, or hsCRP.