Effects of CPAP on Cardiovascular Risk in Obstructive Sleep Apnea (OSA) and Metabolic Syndrome
Condition: Obstructive Sleep Apnea; Metabolic Syndrome
MeSH terms: Apnea; Sleep Apnea Syndromes; Sleep Apnea, Obstructive; Metabolic Syndrome; Syndrome
Study type: Interventional

Summary: 
      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.
    

Detailed description: 
      Patients with obstructive sleep apnea (OSA) are at increased risk of atherosclerotic
      morbidity and mortality.OSA is associated with the development and/or worsening of arterial
      hypertension, a traditional risk factor of atherosclerosis.Moreover, OSA has been linked to
      novel factors related to atherogenesis - metabolic syndrome,systemic inflammation,6 and
      oxidative stress.

      Numerous studies have selectively examined the effects of continuous positive airway pressure
      (CPAP) ventilation, the primary treatment for OSA, on the traditional and novel risk factors
      of atherosclerosis. A recent metaanalysis of 16 randomized trials indicated that CPAP
      decreases blood pressure in patients with OSA.9 Furthermore, reductions in serum total
      cholesterol, C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-alpha), interleukin
      (IL)-6 and IL-8 were demonstrated after effective CPAP therapy.In addition, CPAP was shown to
      reduce systemic oxidative stress.Improvements in insulin sensitivity have been reported in
      some,but not in all studies. Importantly, substantial evidence links the effects of CPAP to
      compliance with this treatment.

      Most observational studies examined the effects of CPAP across a broad-range of OSA severity,
      and have included patients with and without the metabolic syndrome. Up to now, no study
      analyzed the effects of CPAP on glucose and lipid metabolism, systemic inflammation,
      oxidative stress, and the global cardiovascular disease (CVD) risk within the same cohort of
      subjects with severe OSA and concurrent metabolic syndrome. Importantly, the metabolic
      syndrome exacerbates CVD risk over and above that attributable to OSA alone. Therefore,
      reduction of CVD risk in patients with OSA and concurrent metabolic syndrome is of paramount
      importance.

      The primary purpose of the present study was to determine, in patients with severe OSA and
      metabolic syndrome compliant to CPAP, the effects of 8-weeks therapy on the glucose and lipid
      profile, systemic inflammation, oxidative stress, and on the global CVD risk. The secondary
      goal was to analyze factors related to compliance with CPAP.
    

Intervention name(s): CPAP device - REMstar Plus, Respironics, Murrysville, USA
Intervention type(s): Device
Intervention description(s): continuous positive airway pressure device with heated humidification
Other intervention name(s): REMstar Plus, Respironics, Murrysville, Pennsylvania, USA
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: sleep apnea; risk factors; continuous positive airway pressure; insulin resistance; metabolic syndrome; compliance