Effect of Continuous Positive Airway Pressure on Lipid Profiles in Obstructive Sleep Apnea: A Meta-Analysis

Abstract

Background: Obstructive sleep apnea (OSA) is associated with dyslipidemia. However, the effects of continuous positive airway pressure (CPAP) treatment on lipid profiles are unclear. Methods: PubMed/Medline, Embase and Cochrane were searched up to July 2021. Randomized controlled trials (RCTs) of CPAP versus controls with ≥4 weeks treatment and reported pre- and post-intervention lipid profiles were included. Weighted mean difference (WMD) was used to assess the effect size. Meta-regression was used to explore the potential moderators of post-CPAP treatment changes in lipid profiles. Results: A total of 14 RCTs with 1792 subjects were included. CPAP treatment was associated with a significant decrease in total cholesterol compared to controls (WMD = −0.098 mmol/L, 95% CI = −0.169 to −0.027, p = 0.007, I2 = 0.0%). No significant changes in triglyceride, high-density lipoprotein nor low-density lipoprotein were observed after CPAP treatment (all p > 0.2). Furthermore, meta-regression models showed that age, gender, body mass index, daytime sleepiness, OSA severity, follow-up study duration, CPAP compliance nor patients with cardiometabolic disease did not moderate the effects of CPAP treatment on lipid profiles (all p > 0.05). Conclusions: CPAP treatment decreases total cholesterol at a small magnitude but has no effect on other markers of dyslipidemia in OSA patients. Future studies of CPAP therapy should target combined treatment strategies with lifestyle modifications and/or anti-hyperlipidemic medications in the primary as well as secondary cardiovascular prevention models.

The Role of Continuous Positive Airway Pressure (CPAP) Therapy in Obstructive Sleep Apnea With Metabolic Syndrome: Does It Affect the Outcomes?

“…In our study, we observed significant improvements in HDL and triglycerides. Nadeem et al, Shehab et al, Pazarli et al, and Asgari et al, similar to our study, observed that post-CPAP therapy decreases triglycerides and total cholesterol with an increase in HDL; however, on the contrary, Xu et al and Chen et al suggested no clinically significant effect on lipid metabolism [ 29 - 34 ].…”

Obstructive Sleep Apnoea and Lipid Metabolism: The Summary of Evidence and Future Perspectives in the Pathophysiology of OSA-Associated Dyslipidaemia

“…Moreover, moderate-to-severe OSA, daytime sleepiness, CPAP treatment with short-term duration and good compliance were associated with the changes in lipid profile [ 339 ]. In a recent paper by Chen et al, 14 studies with 1792 subjects were included [ 340 ]. The therapy duration was 4-48 weeks.…”

“…The CPAP therapy significantly decreased the TC levels (−0.09 mmol/L); however, it failed to change the levels of TG (0.07 mmol/L), LDL-C (−0.06 mmol/L) or HDL-C (−0.03 mmol/L). The authors did not find any confounders of CPAP treatment effect on lipid profile changes [ 340 ].…”

Selected routine laboratory tests in the clinical assessment of patients with obstructive sleep apnea

“…However, there are also some reports which present the opposite view, that the concentration of neutrophils does not differ in patients with OSA compared to the healthy population [36,37]. Interestingly, the increased level of neutrophils has also been found in the sputum of patients with OSA, which confirms the existence of a general increased inflammation state among these patients, including their bronchial tree [38].…”