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CPAP Can Help With Metabolic Syndrome

We already know that treating obstructive sleep apnea can help you to sleep better, but there’s been conflicting studies showing the benefits of CPAP on high blood pressure, diabetes, or risk of heart disease. However, for the most part, CPAP has been found to be helpful with hypertension, diabetes and cardiovascular risk factors.

Here’s a small study out of India showing that CPAP significantly lowered various markers for metabolic syndrome (high blood pressure, high cholesterol, and insulin resistance). Eighty-six volunteers (87% had metabolic syndrome) with were randomized to be given CPAP or sham CPAP therapy for 3 months. After 3 months, the two group were reversed. People treated with CPAP had an overall drop of 3.9 mm Hg systolic (top number) blood pressure, and 2.5 mm Hg in the diastolic (bottom) number. Total cholesterol went down 13.1 points, and  LDL dropped 9.6 points. Triglycerides also dropped, by 18.7 points. Thirteen percent no longer had metabolic syndrome.

On a side note, this study was funded by Pfizer, which makes many of the popular medications for high cholesterol and high blood pressure. It’s interesting that they would fund a study that would make it less necessary to use their prescription medications. We know that they don’t manufacture CPAP machines, so I wonder why they funded this study. Could they be interested in entering the sleep apnea market?

Can Sleep Apnea Raise Your Cholesterol Levels?

There's been a lot of press coverage about good and bad cholesterol, as well as studies about various medications that are used to lower high cholesterol levels. The problem with the one variable paradigm of medicine is that illness is not solely a function of one elevated blood test finding. There are hundreds, if not millions of variables that when added together, produces one of the end results that we can measure, like your LDL levels. The same problem applies to allergies, where numerous medications are used to control histamine, which is one of many inflammatory mediators that result from an allergic attack. Amyloid plaques seen in Alzheimer's is another good example.

In all three of the above scenarios (cholesterol, histamine and plaques), wouldn't it be better to control what starts the problem, rather than just covering up the end result? Not too surprisingly, lack of quality or quantity of sleep has been shown again to raise your cholesterol levels (in addition to numerous inflammatory markers and amyloid plaques). In this month's Journal SLEEP, researchers found in teenagers that the less they slept, the higher their risk of developing high cholesterol levels later as an adult. This risk was much higher for women. As a society, we're sleeping about 1 to 1.5 hours less than we did 50 years ago. In a culture where sleep deprivation is glorified ("I get by on only 5 hours of sleep") these findings are not too surprising. 

There are numerous proposed explanations as to how poor sleep can lead to increased (bad) cholesterol levels, but the common pathway seems to be metabolic effects on the liver. There are other studies that show accumulation of fat cells in sleep apnea patients, similar to what's seen in alcoholics. Sleep restriction also causes decreased glucose tolerance, increased cortisol levels, decreased the satiety hormone ghrelin, and increased hunger and appetite.

How many of you were placed on cholesterol medications long before you were diagnosed with obstructive sleep apnea?

Sleep Apnea, Statins, & Stroke: A Travesty?

The standard of care after stroke these days is to give high-dose statins (cholesterol lowering drugs), in order to prevent a second stroke. Researchers reported that although rates of statin therapy after stoke are improving (from 75 to 85%), more needs to be done to encourage doctors to prescribe statins to everyone who suffers a stroke. This recommendation was based on the SPARCL trial, which showed that loading up on high doses of statins after an initial stroke lowered the rate of repeat strokes. If you actually read through the details, it shows that the absolute drop was 2.2% over 5 years, and 16% relative risk reduction. But despite the finding that Lipitor actually increased the risk of hemorrhagic stroke, the investigators still recommended starting statin therapy soon after a stroke or TIA.

Despite the well-intentioned recommendations by medical researchers, they're completely missing the boat. This situation reminds me of Dr. Mercola's video, The Town of Allopath. You should definitely watch this video. In summary, the town of Allopath (pun intended) had too many traffic accidents at an intersection without traffic lights. An expert was brought in from the Motor Division (MD) to determine the cause of these accidents. A town meeting was convened, and the expert proudly announced the cause of all the accidents: tire skid marks. With great enthusiasm, they decide to cover up the skid marks with Teflon, thinking that if you prevent skidding, then you won't have any more accidents. You can imagine what happens next. 

In the same way, elevated LDL cholesterol levels is only a sign of conditions that predisposes you to having a stroke. Having sleep apnea can cause liver dysfunction and altered lipid metabolism. We also know that most stroke patients have sleep apnea, and that having sleep apnea increases your chances of stroke by 2-3 times normal. I would think that screening for obstructive sleep apnea and treating it is a much more effective way of preventing second strokes.

What do you think about my recommendation? Am I going too far, or not far enough? Please enter your comments in the text box below.

Another Important (Boring) Finding

A study published in the Oct. 30 edition of the the New England Journal of Medicine reported that CRP, a marker of inflammation and heart disease, does not cause heart disease. Rather, it’s just an innocent bystander (Surprise!). The same can be said for almost every medication out there that targets specific biochemical markers, such as for high cholesterol, high blood pressure and depression. Researchers are so caught up linking biochemical markers for various disorders, that somehow, the words "linking" or "associated with" slowly morphs into "causes." So then the search goes on to lower or eradicate this particular marker, thinking that this will somehow get rid of the disease. 

Imagine if you were allergic to dust and the dust particle sets off an allergic reaction in your nose that turns into an inflammatory cascade, almost like a tree trunk that branches into hundred or thousands of smaller branches and so forth. If one biochemical process is the equivalent of one particular branch, of course you’ll see the same branch with the same tree trunk. But cutting off this particular branch, although it may make you feel better, won’t get rid of the tree. The same analogy holds for most of modern medicine, including allergies. Shutting down histamine production may help your allergies feel better, but you have to keep using the medication to stay that way. You’re also not addressing the other hundreds or thousands of other known and unknown inflammatory markers that wreak havoc in other ways.

I predict there will be a proliferation of other biochemical markers that are found to be linked or associated with a medical condition, with researchers and drug companies jumping on the bandwagon to block this chemical, only to find later that it doesn’t work in the long term. 

Do you have other examples of not seeing the forest from the trees?

 

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