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Effects of CPAP on Cardiovascular Risk Profile in Patients with Severe Obstructive Sleep Apnea and Metabolic Syndrome

¹Department of Respiratory Medicine, Faculty of Medicine, P.J. Safarik University and L. Pasteur Teaching Hospital, Kosice ²Institute of Experimental Medicine, Faculty of Medicine, Kosice, and ³Department of Biochemistry, LABMED, Kosice, Slovakia

rtkacova{at}medic.upjs.sk

Abstract

Background: The increased risk of atherosclerotic morbidity and mortality in patients with obstructive sleep apnea (OSA) has been linked to arterial hypertension, insulin resistance, systemic inflammation, and oxidative stress in previous studies. We aimed to determine the effects of 8-weeks therapy with continuous positive airway pressure (CPAP) on glucose and lipid profile, systemic inflammation, oxidative stress, and the global cardiovascular disease (CVD) risk in patients with severe OSA and metabolic syndrome.

Methods: In 32 patients, serum cholesterol, triglycerides, high density lipoprotein (HDL) cholesterol, fibrinogen, apolipoprotein A-I (ApoA-I), apolipoprotein B (ApoB), high sensitivity C-reactive protein (CRP), interleukin 6 (IL-6), tumor necrosis factor- (TNF-), leptin, malondialdehyde (MDA) and erythrocytic glutathione peroxidase (GPx) activity were measured at baseline and after 8 weeks of CPAP. Insulin resistance index (HOMA-IR) was based on the homeostasis model assessment method, the CVD risk was calculated using the multivariable risk factor algorithm.

Results: In patients who used CPAP for 4 h.night^-1 (n=16), CPAP therapy reduced systolic and diastolic blood pressure (p=0.001; p=0.006, respectively), total cholesterol (p=0.002), ApoB (p=0.009), HOMA-IR (p=0.031), MDA (p=0.004), and TNF- (p=0.037), and increased erythrocytic GPx activity (p=0.015), in association with reductions in the global CVD risk (from 18.8±9.8 to 13.9±9.7%, p=0.001). No significant changes were seen in patients who used CPAP for <4 h.night^-1. Mask leak was the strongest predictor of compliance with CPAP therapy.

Conclusions: In patients with severe OSA and metabolic syndrome, good compliance to CPAP may improve insulin sensitivity, reduce systemic inflammation and oxidative stress, and reduce the global CVD risk. Study registered at www.clinicaltrials.gov,No NCT00635674 [ClinicalTrials.gov]

Key Words: sleep apnea • risk factors • continuous positive airway pressure • insulin resistance • metabolic syndrome • compliance