Too Much of a Good Thing? Benefits of Lower Pap Settings
Mar 7, 2025
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Dr. Sanja Jelic, a prominent sleep medicine expert at Columbia University, and Dr. Daniel Gottlieb, an Associate Professor at Brigham and Women's Hospital, dive deep into the potential inflammatory effects of high-pressure PAP therapy for sleep apnea. They tackle eye-opening findings on how PAP settings might influence inflammatory markers and challenge existing beliefs about CPAP efficacy. Plus, they explore innovative alternatives like supplemental oxygen and advocate for personalized treatment to enhance cardiovascular health and overall outcomes in sleep medicine.
Recent studies indicate that high-pressure CPAP therapy may inadvertently increase inflammatory markers like angiopoietin-2, questioning its cardiovascular benefits.
Exploring alternative treatments such as supplemental oxygen could provide better outcomes for patients with obstructive sleep apnea who resist CPAP therapy.
Deep dives
CPAP Therapy and Cardiovascular Risk
Despite expectations that treating obstructive sleep apnea with CPAP therapy would reduce cardiovascular risk due to the alleviation of intermittent hypoxia, recent studies have shown no significant decrease in this risk. Research conducted by Dr. Jellick and Dr. Gottlieb suggests that instead of lowering cardiovascular markers, CPAP may lead to an unexpected increase in certain inflammatory mediators, such as angiopoietin 2. This contradiction highlights the complexities of understanding how sleep apnea treatments impact overall health, particularly for patients with a history of cardiovascular events. The surprising findings challenge existing beliefs and emphasize the need for further exploration into the effects of CPAP on non-symptomatic individuals.
Inflammatory Biomarkers and Sleep Apnea Treatment
A significant observation from recent studies is that levels of angiopoietin 2—a biomarker related to inflammation—actually rise with CPAP therapy, contrary to the anticipated decrease following treatment. In evaluations of patients who recently underwent coronary revascularization, higher baseline levels of angiopoietin were noted, indicating a direct correlation with sleep apnea severity. The persistence of elevated angiopoietin levels post-treatment could imply that CPAP therapy is not providing the cardiovascular benefits that are typically expected. This shift prompts a reevaluation of treatment protocols and the monitoring of inflammatory markers in patients receiving CPAP.
Potential Advantages of Alternative Treatments
Given the mixed results associated with CPAP therapy, alternative treatments such as supplemental oxygen are being reconsidered for patients with obstructive sleep apnea. Some evidence suggests that oxygen administration could lower blood pressure better than CPAP, although the long-term effects and potential complications related to oxygen therapy remain unclear. The exploration of supplemental oxygen as an alternative could present an important opportunity for patients who are minimally symptomatic or resistant to CPAP treatment. This approach warrants further research to assess its therapeutic benefits and safety compared to traditional CPAP therapy.
Individualizing Sleep Apnea Treatment
The discussions around the appropriateness of CPAP pressures underscore the importance of personalized medicine in sleep apnea management. Recent data indicates that higher pressure settings may correlate with increased cardiovascular risk, suggesting a need for more conservative treatment approaches. By considering patient-specific factors like body habitus and sleep apnea severity, clinicians can optimize treatment to minimize risks while still addressing symptoms effectively. This individualized approach could help balance the benefits of therapy against potential adverse effects, ultimately improving patient outcomes in managing obstructive sleep apnea.
In this episode, host Dr. Seema Khosla explores a provocative question in sleep medicine: Could high pressure PAP therapy have unexpected inflammatory effects? Joined by Dr. Sanja Jelic from Columbia University and Dr. Daniel Gottlieb from Brigham and Women's Hospital, the discussion examines emerging research that challenges conventional wisdom about positive airway pressure (PAP) therapy.
Discover groundbreaking findings on how PAP settings may influence inflammatory biomarkers like angiopoietin-2 (AP2) and VEGF-A, potentially explaining why cardiovascular outcomes in clinical trials haven't consistently shown improvement with PAP therapy. Learn about pressure optimization strategies, alternatives to high-pressure PAP therapy, and implications for treating
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