Sleep Apnea Recurs Within Days of CPAP Withdrawal

Obstructive sleep apnea returns within a few days of continuous positive airway pressure withdrawal

MONDAY, Aug. 15 (HealthDay News) -- In patients with obstructive sleep apnea (OSA) on continuous positive airway pressure (CPAP), withdrawal of CPAP is associated with rapid recurrence of OSA and subjective sleepiness, according to a study published online Aug. 11 in the American Journal of Respiratory and Critical Care Medicine.

Malcolm Kohler, M.D., from the University Hospital Zurich in Switzerland, and colleagues evaluated the effects of CPAP withdrawal in 41 patients with OSA who were on CPAP. The participants were randomized to either CPAP withdrawal or CPAP continuation (therapeutic CPAP) for two weeks. Parameters assessed included: polysomnography, sleepiness, psychomotor performance, endothelial function, blood pressure (BP), heart rate (HR), urinary catecholamines, blood markers of systemic inflammation, and metabolism.

The investigators found that CPAP withdrawal was associated with the recurrence of OSA within a few days, and a return of subjective sleepiness, but not with significant deterioration of psychomotor performance, within two weeks. Compared to the therapeutic CPAP group, the CPAP-withdrawal group showed a significant decrease in endothelial function. Compared to therapeutic CPAP, its withdrawal was also associated with a significant elevation in morning systolic and diastolic BP, and morning HR. CPAP withdrawal was correlated with elevated urinary catecholamines, but not with markers of systemic inflammation, insulin resistance, or blood lipids.

"CPAP withdrawal usually leads to a rapid recurrence of OSA, a return of subjective sleepiness, and is associated with impaired endothelial function, increased urinary catecholamines, blood pressure, and heart rate," the authors write.

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