Effect of continuous positive airway pressure on inflammatory, antioxidant, and depression biomarkers in women with obstructive sleep apnea: a randomized controlled trial

Abstract

Study Objectives The effect of continuous positive airway pressure (CPAP) on mediators of cardiovascular disease and depression in women with obstructive sleep apnea (OSA) is unknown. We aimed to assess the effect of CPAP therapy on a variety of biomarkers of inflammation, antioxidant activity, and depression in women with OSA. Methods We conducted a multicenter, randomized controlled trial in 247 women diagnosed with moderate-to-severe OSA (apnea–hypopnea index [AHI] ≥ 15). Women were randomized to CPAP (n = 120) or conservative treatment (n = 127) for 12 weeks. Changes in tumor necrosis factor α (TNFα), interleukin 6 (IL-6), C-reactive protein (CRP), intercellular adhesion molecule 1 (ICAM-1), catalase (CAT), superoxide dismutase (SOD), and brain-derived neurotrophic factor (BDNF) were assessed. Additional analyses were conducted in subgroups of clinical interest. Results Women had a median (25th–75th percentiles) age of 58 (51–65) years, body mass index 33.5 (29.0–38.3) kg/m2, and AHI 33.3 (22.8–49.3). No differences were found between groups in the baseline levels of the biomarkers. After 12 weeks of follow-up, there were no changes between groups in any of the biomarkers assessed. These results did not change when the analyses were restricted to sleepy women or to those with severe OSA. In women with CPAP use at least 5 hours per night, only TNFα levels decreased compared to the control group (−0.29 ± 1.1 vs −0.06 ± 0.53, intergroup difference −0.23 [95% CI = −0.03 to −0.50]; p = 0.043). Conclusions Twelve weeks of CPAP therapy does not improve biomarkers of inflammation, antioxidant activity, or depression compared to conservative treatment in women with moderate-to-severe OSA. Trial Registration NCT02047071.

Relationships Among and Predictive Values of Obesity, Inflammation Markers, and Disease Severity in Pediatric Patients with Obstructive Sleep Apnea Before and After Adenotonsillectomy

“…Based on the literature, the short-term use of continuous positive airway pressure therapy did not seem to improve inflammatory or oxidative biomarkers in OSA patients. Neither did physical activities [53,54]. Our study demonstrated that AT as a procedure to correct adenotonsillar hypertrophy, improved disease severity as well as local and systemic inflammation, without an obvious improvement in obesity.…”

Oxidative Stress and Inflammation Biomarker Expression in Obstructive Sleep Apnea Patients

“…The pro-inflammatory cytokine TNF-α promotes atherosclerosis by inducing the expression of cellular adhesion molecules that mediate adhesion of leukocytes to the vascular endothelium [ 83 , 84 , 85 ]. Circulating levels of TNF-α have been reported to correlate with signs of early atherosclerosis amongst healthy middle-aged men [ 86 , 87 , 88 , 89 , 90 , 91 ]. They are predictive of coronary heart disease and congestive cardiac failure.…”

Anxiety and Depression in Patients with Obstructive Sleep Apnoea before and after Continuous Positive Airway Pressure: The ADIPOSA Study

“…To our knowledge, this is the first study on the presence and changes after CPAP therapy of cognitive-affective depression and anxiety symptoms in patients with OSA including not only the measurement of dysthymia but also the distinctive component of depression, i.e., euthymia. Although the prevalence and treatment response of these symptoms in OSA have been widely addressed in previous epidemiological and original research [16][17][18][34][35][36][37][38][39][40], the use of mood disturbances scales including overlapping symptoms, as well as the non-consideration of euthymia as the distinctive feature of depression, have potentially led to inconsistencies and unclear results in this field. Our results therefore have robust clinical and research implications, further supporting the potential overestimation of depression and anxiety prevalence in patients with OSA found throughout the large body of literature in this field [59].…”

“…Similarly, there have been inconsistent findings regarding CPAP effects on OSA associated depression and anxiety symptoms [34]. While some clinical research found that a twelve-week CPAP use significantly reduced depression symptoms in patients with moderate to severe OSA [35][36][37], other studies indicated no significant changes in these psychological disturbances after CPAP treatment [38][39][40]. These controversial results may be explained by both (a) cofounder variables in the association between anxiety-depression and OSA, and (b) commonly used anxiety and depression scales.…”