Sleep apnea returns quickly with CPAP withdrawal

Kathleen Blanchard's picture
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Patients who stop CPAP therapy for sleep apnea are likely to have rapid return of symptoms. New research finds daytime sleepiness from stopping therapy for obstructive sleep apnea with continuous positive airway pressure machines causes increased heart rate, high blood pressure and adverse vascular changes within 14 days. Sleepiness returns within a matter of days and OSA returns overnight.

The finding is important for people suffering from sleep apnea who frequently stop CPAP therapy on their own. Many patients fail to comply because they may not understand the importance of OSA treatment. Others claim they can’t tolerate the treatment, or may take breaks from using their machines.

The newest Swiss study shows even stopping sleep apnea therapy for a short period of time can have health implications that should be taken seriously.

According to Malcolm Kohler, MD, senior consultant at the Sleep Disorders Centre and Pulmonary Division of the University Hospital in Zurich, “After 14 days of CPAP withdrawal, OSA patients experienced considerable increases in heart rate and blood pressure as well as deterioration in vascular function.”

In plain terms, CPAP withdrawal could lead to increased risk for heart attack and stroke. In the study, researchers found withdrawing sleep apnea therapy boosted insulin resistance, which is an important finding for diabetics trying to control blood sugar levels.

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OSA, or obstructive sleep apnea, is the most common form of the condition. During sleep, OSA sufferers experience periods of breathing cessation or shallow breaths. The condition leads to sleep disruption from blockage that disrupts air flow. Obesity is a primary cause. Some individuals experience the condition because their tongue relaxes too much, blocking air flow during sleep.

According to the National Heart, Blood and Lung Institute, breathing pauses from sleep apnea can last anywhere from 5 to 30 minutes.

The finding suggests continuance of sleep apnea therapy with CPAP is important for maintaining quality of life and reducing complications and risk factors for heart disease, stroke and diabetes. The study authors say patients with OSA should take their CPAP machines with them even when traveling, based on the finding.

In the newest finding, Swiss researchers found study participants taken off CPAP therapy even for a short period of time, had a rapid return of sleepiness, breathing pauses during sleep, increased heart rate and a significant rise in blood pressure. “We have shown that CPAP withdrawal leads to a return of OSA within the first night off CPAP,” said Dr. Kohler.

Am. J. Respir. Crit. Care Med. 2011, doi:10.1164/rccm.201106-0964OC
"The effects of CPAP therapy withdrawal in patients with obstructive sleep apnea: a randomised controlled trial"
Malcolm Kohler et al.
August 11 2011

Image credit: Wikimedia commons

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