A team led by Ronald Chervin, M.D., M.S., has found evidence that CPAP therapy helps patients not just feel better, but look better, too.

Looking good

CPAP adherence improves appearance

issue 20 | winter 2014

Patients who adhere to continuous positive airway pressure (CPAP) treatment for sleep apnea may not just sleep better — they may look better, too, according to a recent U-M study. The findings may give some patients more incentive to adhere to the risk-reducing but cumbersome treatment.

It's the first time researchers have shown specific improvement in facial appearance after treatment for apnea, which affects millions of adults and elevates risk for cardiovascular issues and accidents. CPAP therapy is already known to improve daytime alertness and reduce blood pressure.

Writing in the Journal of Clinical Sleep Medicine, a team from the U-M Sleep Disorders Center reported results from a sensitive "face mapping" technique usually used by surgeons, and results from a panel of independent appearance raters. The researchers detected changes in 20 middle-aged apnea patients just a few months after they began using CPAP.

"We perceived that our CPAP patients often looked better ... But no one had ever studied this."

Ronald Chervin, M.D., M.S.

Sleep neurologist and center director Ronald Chervin, M.D., M.S., says the study grew out of the anecdotal evidence from patients coming for follow-up visits after using CPAP. The team sought a more scientific way to assess appearance before and after sleep apnea treatment.

"The common lore, that people ‘look sleepy' because they are sleepy, drives people to spend untold dollars on home remedies," notes Chervin. "We perceived that our CPAP patients often looked better, or reported that they'd been told they looked better, after treatment. But no one had ever actually studied this."

The team used a precise face-measuring system called photogrammetry to take an array of images of the patients under identical conditions before CPAP and a few months after. Capable of measuring tiny differences in facial contours, the system is usually used in surgical planning and evaluation.

The research team also developed a way to precisely map the colors of patients' facial skin before and after CPAP treatment.

And they used a subjective test of appearance: 22 independent raters were asked to look at the photos, without knowing which were the "before" pictures and which the "after" pictures of each patient. The raters were asked to rank attractiveness, alertness and youthfulness — and to pick which picture they thought showed the patient after sleep apnea treatment.

About two-thirds of the time, the raters stated that the patients in the post-treatment photos looked more alert, more youthful and more attractive. The raters also correctly identified the post-treatment photo two-thirds of the time.

Meanwhile, objective measures showed that patients' foreheads were less puffy, and their faces were less red, after CPAP treatment. However, they did not document any improvement, after treatment, in tendency to have dark blue circles or puffiness under the eyes.

Chervin notes that further research, on patients with a longer CPAP experience, is needed.