Gender-specific change in leptin concentrations during long-term CPAP therapy

Abstract

Purpose Nasal continuous positive airway pressure (CPAP) alleviates sleepiness in patients with obstructive sleep apnoea syndrome (OSAS), but part of OSAS patients keep gaining weight. Leptin and insulin-like growth factor-1 (IGF-1) interact with energy balance, and CPAP therapy has been suggested to influence these endocrine factors. We hypothesised that leptin would decrease during long-term CPAP therapy, and weight gain would associate with OSAS severity, lower CPAP adherence, lower IGF-1, and leptin concentrations. Methods Consecutive patients (n = 223) referred to sleep study with suspected OSAS were enrolled. Patients underwent cardiorespiratory polygraphy at baseline. Questionnaires were completed, and blood samples were drawn both at baseline and after 3 years. A total of 149 (67%; M 65, F 84) patients completed the follow-up. Plasma samples were available from 114 patients, 109 of which with CPAP adherence data (49 CPAP users, 60 non-users).Results At baseline, the CPAP users were more obese and had more severe OSAS than the non-users. Leptin concentrations did not differ. After follow-up, leptin concentrations were higher in CPAP users (30.2 ng/ml vs. 16.8 ng/ml; p = 0.001). In regression analysis, increase in leptin concentrations was independent of age, baseline body mass index (BMI), or the change in BMI. Leptin concentrations increased among females (− 8.9 vs. 12.7 ng/ml; p < 0.001); whereas in men, CPAP did not have an effect, if not opposed the natural decrease in leptin observed in men not using CPAP. Change in IGF-1 levels did not differ. Conclusions Our results suggest increase in leptin concentrations during long-term CPAP therapy among females.

The Association Between Serum/Plasma Leptin Levels and Obstructive Sleep Apnea Syndrome: A Meta-Analysis and Meta-Regression

“…Therefore, hyperleptinemia and leptin resistance may play important roles in the occurrence and development of OSAS. In addition to obesity, lipid metabolism disorders, systemic inflammatory responses, and oxidative stress, leptin levels were also affected by sex differences, circadian rhythm of leptin secretion, metabolic disease, and lifestyle, among others ( 68 – 70 ). However, because these parameters cannot be extracted from all or at least most of the included studies, it is impossible to carry out further subgroup analyses.…”

Restarting CPAP Therapy for Sleep Apnea After a Previous Failure

“…We also observed no difference in CPAP adherence at CPAP initiation for the first time, which is consistent with a previous study. 13 The difference in adherence at re-initiation may be related to the way men and women approach CPAP therapy. Previous studies on relapses in smoking-cessation trials reported that women were more likely than men to transition from being a former smoker to a current smoker.…”

A Review of the Associations Between Obstructive Sleep Apnea and Gestational Diabetes Mellitus and Possible Mechanisms of Disease

“…Leptin levels are higher in extreme situations where sleep time is shorter or longer [ 93 ]. Additionally, leptin levels were elevated in OSA and decreased after CPAP treatment, accompanying the increase of insulin secretion [ 94 , 95 ]. Meanwhile, leptin is significantly associated with IR in patients with moderate-to-severe OSA [ 96 ].…”