Effect of Continuous Positive Airway Pressure Treatment on Serum Cardiovascular Risk Factors in Patients With Obstructive Sleep Apnea-Hypopnea Syndrome

Steiropoulos, Paschalis; Tsara, Venetia; Nena, Evangelia; Fitili, Christina; Kataropoulou, M.; Froudarakis, Marios; Christaki, Pandora; Bouros, Demosthenes

doi:10.1378/chest.07-0074

Cited by 132 publications

(101 citation statements)

References 35 publications

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“…Continuous positive airway pressure (CPAP) therapy improves not only upper airway patency but also the quality of life and reduces the frequency of OSAS-related cardiovascular complications [2][3][4].The underlying mechanisms of the multi-organ complications associated with OSAS are considered to include repetitive upper airway obstruction, hypoxemia and sleep fragmentation. These abnormalities likely result in various neural and metabolic changes, Abstract.…”

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confidence: 99%

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Obstructive sleep apnea syndrome causes a pseudo-Cushing’s state in Japanese obese patients with type 2 diabetes mellitus

et al. 2013

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OBSTRUCTIVE SLEEP APNEA SYNDROME (OSAS) is associated with increased risk of hypertension, diabetes mellitus, myocardial infarction, congestive heart failure, and stroke [1,2]. Continuous positive airway pressure (CPAP) therapy improves not only upper airway patency but also the quality of life and reduces the frequency of OSAS-related cardiovascular complications [2][3][4].The underlying mechanisms of the multi-organ complications associated with OSAS are considered to include repetitive upper airway obstruction, hypoxemia and sleep fragmentation. These abnormalities likely result in various neural and metabolic changes, Abstract. Activation of the hypothalamic-pituitary-adrenal axis has been reported in some patients with the obstructive sleep apnea syndrome (OSAS). In current study, we investigated whether OSAS affect the screening test for subclinical Cushing's disease using 0.5 mg overnight dexamethasone suppression test (DST) in Japanese obese diabetic patients with OSAS. Among Japanese obese patients with type 2 diabetes mellitus who had been hospitalized in our department, we selected 20 patients with moderate to severe untreated OSAS (apnea-hypoxia index, AHI, of ≥15 events/hour). All patients underwent 0.5 mg DST. The same test was repeated in patients with positive response of it within a few days after continuous positive airway pressure (CPAP) therapy. We found that five patients showed positive response of DST (25%). Three of these patients continued to use CPAP, and they showed normal response of DST after CPAP therapy. Serum cortisol after 0.5 mg DST measured before CPAP therapy correlated significantly with fasting serum cortisol level (r=0.764, p<0.0001), but not with various clinical parameters, including AHI (p=0.784), body mass index (p=0.984), waist circumference (p=0.957), HbA1c (p=0.261), fasting plasma glucose (p=0.420) and HOMA-IR (p=0.500). Our study show that OSAS causes a pseudo-Cushing's syndrome in obese patients with type 2 diabetes mellitus, which phenomena can be reversed by CPAP therapy.

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Obstructive sleep apnea syndrome causes a pseudo-Cushing’s state in Japanese obese patients with type 2 diabetes mellitus

et al. 2013

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“…Our group and others have shown a gradual decrease of CRP levels with effective PAP therapy, which could subsequently improve cardiovascular morbidity associated with OSAS [19,[65][66][67][68][69] , whereas others found that PAP therapy did not significant change CRP levels, regardless of PAP therapy duration [39,42,65,[70][71][72][73][74] . Furthermore our study [60] showed that after PAP therapy CRP was decreased more slowly in females compared to matched for OSAS severity males.…”

Section: Effect Of Positive Airway Pressure Therapy On Levels Of Crpmentioning

confidence: 66%

Obstructive sleep apnea syndrome and cardiovascular disease: The influence of C-reactive protein

Bouloukaki¹,

Mermigkis²,

Kallergis³

et al. 2015

WJEM

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Obstructive sleep apnea syndrome (OSAS) is a common medical condition, associated with atherosclerosis and cardiovascular disease (CVD). The underlying pathophysiologic mechanisms of this association have not been completely understood and may be multifactorial in origin. A number of studies suggest that inflammatory processes have emerged critical in the pathogenesis of CVD in OSAS. A range of circulating inflammatory molecules has been identified and measured, with a view to assess inflammation and predict vascular damage risk, such as plasma cytokines, adhesion molecules, and C-reactive protein (CRP). CRP is a relevant marker worthy of further study, because not only is elevated in patients with OSAS, but also is rapidly becoming a risk factor for cardiac disease. Furthermore, in selected OSAS patients, aggressive treatment of the disorder may lead to retarding or even improvement of CVD progression. However, still there is a debate on the true correlation between CRP and OSAS, as well as the clinical effect of any reduction after OSAS treatment. Further research is required to define those OSAS patients who will have a considerable reduction with treatment, as well as to understand the significance of the interaction between cardiovascular risk factor and CRP reduction in patients with OSAS.

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“…These data have been confirmed by experimental models in humans aimed at modifying sleep duration or quality [11,12]. Normalisation of SDB may improve several determinants of cardio-metabolic risk, such as improvement in lipid profile and glycaemic control, decrease in visceral adipose tissue and decrease in autonomic sympathetic activity [13,14]. However, such improvements are not systematically reported [15,16], even when taking into account the effects of treatment compliance and obesity, and the metabolic impact of OSAHS treatment is highly variable.…”

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confidence: 85%

Sleep apnoea syndrome: how will physiologic knowledge position personalised medicine?

Sériès¹

2011

Eur Respir Rev

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Effect of Continuous Positive Airway Pressure Treatment on Serum Cardiovascular Risk Factors in Patients With Obstructive Sleep Apnea-Hypopnea Syndrome

Cited by 132 publications

References 35 publications

Obstructive sleep apnea syndrome causes a pseudo-Cushing’s state in Japanese obese patients with type 2 diabetes mellitus

Obstructive sleep apnea syndrome causes a pseudo-Cushing’s state in Japanese obese patients with type 2 diabetes mellitus

Obstructive sleep apnea syndrome and cardiovascular disease: The influence of C-reactive protein

Sleep apnoea syndrome: how will physiologic knowledge position personalised medicine?

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