Effect of CPAP treatment on endothelial function and plasma CRP levels in patients with sleep apnea

Panoutsopoulos, Athanasios; Kallianos, Anastasios; Kostopoulos, Konstantinos; Seretis, Charalampos; Koufogiorga, Eleni; Protogerou, Athanase D.; Trakada, Georgia; Kostopoulos, Charalampos; Zakopoulos, Nikolaos; Nikolopoulos, Ioannis

doi:10.12659/msm.883603

Cited by 38 publications

(32 citation statements)

References 37 publications

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“…Thus, it is challenging to integrate our findings with the existing literature. Several studies suggest that FMD may be reduced among groups with disrupted sleep, such as adults doing night shift work and patients with confirmed OSA and (Amir et al,2004;Patt et al,2010), with other work reporting that patients with OSA who were treated with continuous positive airway pressure (CPAP) showed increased FMD (Panoutsopoulos et al,2012). The current study extends those findings by finding associations between sleep quality and FMD among non-shift working adults sampled from the general population, who did not have a previously diagnosed sleep disorder.…”

Section: Discussionsupporting

confidence: 75%

Endothelial function and sleep: Associations of flow-mediated dilation with perceived sleep quality and rapid eye movement (REM) sleep

Cooper¹,

Milic²,

Ancoli‐Israel³

et al. 2013

PsycEXTRA Dataset

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SummaryEndothelial function typically precedes clinical manifestations of cardiovascular disease and provides a potential mechanism for the associations observed between cardiovascular disease and sleep quality. This study examined how subjective and objective indicators of sleep quality relate to endothelial function, as measured by brachial artery flow-mediated dilation (FMD). In a clinical research center, 100 non-shift working adults (mean age: 36 years) completed FMD testing and the Pittsburgh Sleep Quality Index, along with a polysomnography assessment to obtain the following measures: slow wave sleep, percentage rapid eye movement (REM) sleep, REM sleep latency, total arousal index, total sleep time, wake after sleep onset, sleep efficiency, and apnea hypopnea index. Bivariate correlations and followup multiple regressions examined how FMD related to subjective (i.e., Pittsburgh Sleep Quality Index scores) and objective (i.e., polysomnography-derived) indicators of sleep quality. After FMD showed bivariate correlations with Pittsburgh Sleep Quality Index scores, percentage REM sleep, and REM latency, further examination with separate regression models indicated that these associations remained significant after adjustments for sex, age, race, hypertension, body mass index, apnea hypopnea index, smoking, and income (p's<0.05). Specifically, as FMD decreased, scores on the Pittsburgh Sleep Quality Index increased (indicating decreased subjective sleep quality) and percentage REM sleep decreased, while REM sleep latency increased (p's<0.05). Poorer subjective sleep quality and adverse changes in REM sleep were associated with diminished vasodilation, which could link sleep disturbances to cardiovascular disease.

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Section: Discussionsupporting

confidence: 75%

Endothelial function and sleep: Associations of flow-mediated dilation with perceived sleep quality and rapid eye movement (REM) sleep

Cooper¹,

Milic²,

Ancoli‐Israel³

et al. 2013

PsycEXTRA Dataset

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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: 65%

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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“…38 The beneficial effect of CPAP on endothelial dysfunction in subjects with OSA partially stems from reductions in oxidative and inflammatory activities, as well as improvements in both endothelial repair capacity and nitric oxide bioavailability. [10][11][12][13][14][15][16][17][18][19][20] The subgroup analysis showed that with respect to improved FMD, a longer duration of CPAP was no better than a shorter duration (2.49% vs 3.73%). After 1 week, CPAP significantly changed the FMD of subjects with OSA compared with the baseline level, from 3.3 Ϯ 0.3% Fig.…”

Section: Discussionmentioning

confidence: 99%

“…Numerous studies have also explored the effects of CPAP on FMD as a surrogate vascular outcome. [10][11][12][13][14][15][16][17][18][19][20] Although these studies demonstrated the favorable effect of CPAP on endothelial function, confounding factors such as obesity, insulin resistance, and metabolic syndrome, all of which influence endothelial function, must also be taken into account. In this review, we sought to retrieve all published studies on the effects of CPAP on FMD and NMD in subjects with OSA and to quantify the potential contribution of CPAP to improving endothelial function.…”

Section: Introductionmentioning

confidence: 99%

Effect of CPAP on Endothelial Function in Subjects With Obstructive Sleep Apnea: A Meta-Analysis

Wang

Guan

et al. 2015

Respir Care

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Obstructive sleep apnea (OSA) is related to endothelial dysfunction. CPAP is the first-line treatment for OSA. We conducted a meta-analysis to evaluate the effect of CPAP on endothelial function in subjects with OSA. The PubMed, Embase, and Cochrane Library databases were searched. The overall effects were measured by the weighted mean difference with a 95% CI. Subgroup and meta-regression analyses were used to explore the sources of between-study heterogeneity. Eleven studies were eligible for the meta-analysis. A random-effects model revealed that CPAP significantly improved endothelial function as assessed by flow-mediated dilation (weighted mean difference of 2.92, 95% CI 2.21-3.63, P < .001), whereas there was no significant improvement in endothelial function in response to nitroglycerin-mediated dilation (weighted mean difference of 0.90, 95% CI ؊1.63 to 3.43, P ‫؍‬ .48). Age, sex, CPAP compliance and duration, and sleep-related variables had no effect on reduction in arterial stiffness after CPAP. Sensitivity analyses indicated that the protective effect of CPAP on endothelial function was robust. CPAP significantly improved flow-mediated dilation in subjects with OSA. Long-term randomized controlled trials with larger sample sizes are needed to confirm the positive effect of CPAP on endothelial function in subjects with OSA.

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Effect of CPAP treatment on endothelial function and plasma CRP levels in patients with sleep apnea

Cited by 38 publications

References 37 publications

Endothelial function and sleep: Associations of flow-mediated dilation with perceived sleep quality and rapid eye movement (REM) sleep

Endothelial function and sleep: Associations of flow-mediated dilation with perceived sleep quality and rapid eye movement (REM) sleep

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

Effect of CPAP on Endothelial Function in Subjects With Obstructive Sleep Apnea: A Meta-Analysis

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