CPAP Therapy Helps Patients Sleep-and Look-Better

Patients with obstructive sleep apnea (OSA) who use continuous positive airway pressure (CPAP) therapy can get a good night’s sleep and a bonus benefit-they may also look better, according to the results of a new study.

“Primary care physicians can tell their sleep apnea patients that not only will they be healthier if they use their CPAP, but they may well look more alert, more attractive, and more youthful in a way that will be apparent to those around them,” lead author Ronald Chervin, MD, MS, director of the University of Michigan Sleep Disorders Center in Ann Arbor, told ConsultantLive.

With a sensitive “face mapping” technique usually used by surgeons, and a panel of independent appearance raters, the researchers detected changes in 20 middle-aged patients with OSA just a few months after they began using CPAP to help them breathe better during sleep and overcome chronic sleepiness.

Chervin and colleagues performed highly precise 3-dimensional digital photogrammetry before and after at least 2 months of adherent use of CPAP therapy. Then 22 raters assessed pre- and post-treatment facial images, paired side-by-side in random order.

The patients in the post-treatment photos looked more alert, more youthful, and more attractive about two-thirds of the time, the raters stated. They also correctly identified the post-treatment photo two-thirds of the time.
 
The objective measures of facial appearance showed that patients’ foreheads were less puffy and their faces were less red after CPAP treatment. The redness reduction was especially visible in 16 Caucasian patients and was associated with the independent raters’ tendency to say a patient looked more alert in the post-treatment photo. The researchers also perceived, but did not have a way to measure, a reduction in forehead wrinkles after treatment.

“Perhaps the changes we saw reflected better cardiac output, decreased accumulation of fluid in the legs during the day, and decreased transfer of that fluid into swelling in the face during the night,” Dr Chervin said. “Untreated sleep apnea impairs heart function (cardiac output). When sleep apnea is treated, cardiac output may improve, meaning in part that the heart may keep fluids from accumulating during the day in the lower extremities. When we lie down each night, accumulated fluids in the lower extremities may redistribute to the upper body, neck, and head.”

The study grew out of the anecdotal evidence that sleep center staff often thought sleep apnea patients looked better during follow-up visits after using CPAP. However, Dr Chervin said, “We were surprised that our approach could not document any improvement after treatment in the tendency to have dark blue circles or puffiness under the eyes.” Further research is needed to assess facial changes in more patients and over a longer period of CPAP treatment, he noted.

“Physicians of all types might be able to use pictures taken before and after CPAP to help convince patients to continue using their CPAP on a nightly basis,” said Dr Chervin. “Diagnosis and treatment of sleepy patients with OSA stands to benefit affected individuals in many ways, including their appearance.”

The researchers reported their results in the September 2013 issue of the Journal of Clinical Sleep Medicine.