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Lipid profile after long-term APAP in OSA patients

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Abstract

Purpose

This study aimed to explore the impact of an 8-year therapy with autoadjusting positive airway pressure (APAP) on fasting lipid level in a sample of Portuguese moderate/severe obstructive sleep apnea (OSA) patients. Besides contributing to the comprehension of the complex relationship between dyslipidemia and OSA, it provided new data regarding the effectiveness of a long term APAP treatment.

Methods

Thirty-nine male patients with moderate to severe OSA were included in the study. APAP was prescribed to all patients. Fifteen patients were under lipid-lowering medication throughout the study, and another 15 patients never used lipid-lowering medication at any time during the study. Fasting morning venous blood samples were collected at three time points (baseline 6 months and 8 years) and lipids were estimated. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) 21.0 software.

Results

After 8 years of APAP treatment, patients presented a similar body mass index but a significantly less severe daytime sleepiness. Patients on lipid-lowering medication exhibited a higher reduction in total cholesterol than those naïf from that medication, but the reduction was not statistically significant after adjusting for medication and APAP adherence.

Conclusions

Long-term APAP treatment improves OSA but does not seem to contribute to changes in fasting lipids.

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References

  1. Gruber A, Horwood F, Sithole J, Ali NJ, Idris I (2006) Obstructive sleep apnoea is independently associated with the metabolic syndrome but not insulin resistance state. Cardiovasc Diabetol 5:22

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  2. Fusetti M, Fioretti AB, Valenti M, Masedu F, Lauriello M, Pagliarella M (2012) Cardiovascular and metabolic comorbidities in patients with obstructive sleep apnoea syndrome. Acta Otorhinolaryngol Ital 32:320–325

    PubMed Central  CAS  PubMed  Google Scholar 

  3. Punjabi NM (2008) The epidemiology of adult obstructive sleep apnea. Proc Am Thorac Soc 5:136–1434

    Article  PubMed Central  PubMed  Google Scholar 

  4. McNicholas WT, Bonsigore MR (2007) Sleep apnoea as an independent risk factor for cardiovascular disease: current evidence, basic mechanisms and research priorities. Eur Respir J 29:156–178

    Article  CAS  PubMed  Google Scholar 

  5. Peppard PE, Young T, Barnet JH, Palta M, Hagen EW, Hla KM (2013) Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol 177:1006–1014

    Article  PubMed Central  PubMed  Google Scholar 

  6. Terán-Santos J, Jiménez-Gómez A, Cordero-Guevara J (1999) The association between sleep apnea and the risk of traffic accidents. N Engl J Med 340:847–851

    Article  PubMed  Google Scholar 

  7. Lacasse Y, Godbout C, Sériès F (2002) Health-related quality of life in obstructive sleep apnoea. Eur Respir J 19:499–503

    Article  CAS  PubMed  Google Scholar 

  8. Sjösten N, Kivimäki M, Oksanen T, Salo P, Saaresranta T, Virtanen M, Pentti J, Vahtera J (2009) Obstructive sleep apnoea syndrome as a predictor of work disability. Respir Med 103:1047–1055

    Article  PubMed  Google Scholar 

  9. Redline S, Yenokyan G, Gottlieb DJ, Shahar E, O’Connor GT, Resnick HE, Diener-West M, Sanders MH, Wolf PA, Geraghty EM, Ali T, Lebowitz M, Punjabi NM (2010) Obstructive sleep apnea-hypopnea and incident stroke: the Sleep Heart Health Study. Am J Respir Crit Care Med 82:269–277

    Article  Google Scholar 

  10. Chami HA, Resnick HE, Quan SF, Gottlieb DJ (2011) Association of incident cardiovascular disease with progression of sleep-disordered breathing. Circulation 123:1265–1266

    Article  Google Scholar 

  11. Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S (1993) The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 328:1230–1235

    Article  CAS  PubMed  Google Scholar 

  12. Jackson ML, Howard ME, Barnes M (2011) Cognition and daytime functioning in sleep-related breathing disorders. Prog Brain Res 190:53–68

    Article  PubMed  Google Scholar 

  13. Marin JM, Carrizo SJ, Vicente E, Agusti AG (2005) Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet 365:1046–1053

    Article  PubMed  Google Scholar 

  14. Tasali E, Ip MS (2008) Obstructive sleep apnea and metabolic syndrome: alterations in glucose metabolism and inflammation. Proc Am Thorac Soc 5:207–217

    Article  PubMed  Google Scholar 

  15. Jean-Louis G, Zizi F, Clark LT, Brown CD, McFarlane SI (2008) Obstructive sleep apnea and cardiovascular disease: role of the metabolic syndrome and its components. J Clin Sleep Med 4:261–272

    PubMed Central  PubMed  Google Scholar 

  16. Adedayo AM, Olafiranye O, Smith D, Hill A, Zizi F, Brown C, Jean-Louis G (2014) Obstructive sleep apnea and dyslipidemia: evidence and underlying mechanism. Sleep Breath 18:13–18

    Article  PubMed  Google Scholar 

  17. Garcia-Rio F, Alonso-Fernández A, Armada E, Mediano O, Lores V, Rojo B, Fernández-Lahera J, Fernández-Navarro I, Carpio C, Ramírez T (2013) CPAP effect on recurrent episodes in patients with sleep apnea and myocardial infarction. Int J Cardiol 168:1328–1335

    Article  PubMed  Google Scholar 

  18. Pack AI, Gislason T (2009) Obstructive sleep apnea and cardiovascular disease: a perspective and future directions. Prog Cardiovasc Dis 51:434–451

    Article  CAS  PubMed  Google Scholar 

  19. Sopkova Z, Berneis K, Rizzo M, Spinas GA, Dorkova Z, Tisko R, Tkacova R (2012) Size and subclasses of low-density lipoproteins in patients with obstructive sleep apnea. Angiology 63:617–621

    Article  PubMed  Google Scholar 

  20. Drager LF, Lopes HF, Maki-Nunes C, Trombetta IC, Toschi-Dias E, Alves MJ, Fraga RF, Jun JC, Negrão CE, Krieger EM, Polotsky VY, Lorenzi-Filho G (2010) The impact of obstructive sleep apnea on metabolic and inflammatory markers inconsecutive patients with metabolic syndrome. PLoS ONE 5:e12065

    Article  PubMed Central  PubMed  Google Scholar 

  21. Vatansever E, Surmen-Gur E, Ursavas A, Karadag M (2011) Obstructive sleep apnea causes oxidative damage to plasma lipids and proteins and decreases adiponectin levels. Sleep Breath 15:275–282

    Article  PubMed  Google Scholar 

  22. Rosenberg R, Doghramji P (2009) Optimal treatment of obstructive sleep apnea and excessive sleepiness. Adv Ther 26:295–312

    Article  PubMed  Google Scholar 

  23. Kohler M, Stoewhas A-C, Ayers L, Senn O, Bloch KE, Russi EW, Stradling JR (2011) Effects of continuous positive airway pressure therapy withdrawal in patients with obstructive sleep apnea: a randomized controlled trial. Am J Respir Crit Care Med 184:1192–1199

    Article  PubMed  Google Scholar 

  24. Malhotra A, Ayas NT, Epstein LJ (2000) The art and science of continuous positive airway pressure therapy in obstructive sleep apnea. Curr Opin Pulm Med 6:490–495

    Article  CAS  PubMed  Google Scholar 

  25. Steiropoulos P, Tsara V, Nena E, Fitili C, Kataropoulou M, Froudarakis M, Christaki P, Bouros D (2007) Effect of continuous positive airway pressure treatment on serum cardiovascular risk factors in patients with obstructive sleep apnea-hypopnea syndrome. Chest 132:843–851

    Article  CAS  PubMed  Google Scholar 

  26. Nussbaumer Y, Block KE, Genser T, Thurneer R (2006) Equivalence of autoadjusted and constant continuous positive airway pressure in home treatment of sleep apnea. Chest 129:638–643

    Article  PubMed  Google Scholar 

  27. Massie CA, McArdle N, Hart RW, Schmidt-Nowara WW, Lankford A, Hudgel DW, Gordon N, Douglas NJ (2003) Comparison between automatic and fixed positive airway pressure therapy in the home. Am J Respir Crit Care Med 167:20–23

    Article  PubMed  Google Scholar 

  28. Can M, Açikgöz S, Mungan G, Bayraktaroğlu T, Koçak E, Güven B, Demirtas S (2006) Serum cardiovascular risk factors in obstructive sleep apnea. Chest 129:233–237

    Article  CAS  PubMed  Google Scholar 

  29. Coughlin SR, Mawdsley L, Mugarza JA, Wilding JPH, Calverley PMA (2007) Cardiovascular and metabolic effects of CPAP in obese males with OSA. Eur Respir J 29:720–727

    Article  CAS  PubMed  Google Scholar 

  30. Drager LF, Bortolotto LA, Figueiredo AC, Krieger EM, Lorenzi-Filho G (2007) Effects of continuous positive airway pressure on early signs of atherosclerosis in obstructive sleep apnea. Am J Respir Crit Care Med 176:706–712

    Article  CAS  PubMed  Google Scholar 

  31. Roche F, Sforza E, Pichot V, Maudoux D, Garcin A, Celle S, Picard-Kossvsky M, Gaspoz J-M, Barthélémy JC, on behalf of the PROOF study Group (2009) Obstructive sleep apnoea/hypopnea influences high-density lipoprotein cholesterol in the elderly. Sleep Med 10:882–886

    Article  PubMed  Google Scholar 

  32. Mota PC, Drummond M, Winck JC, Santos AC, Almeida J, Marques JA (2011) APAP impact on metabolic syndrome in obstructive sleep apnea patients. Sleep Breath 15:665–672

    Article  PubMed  Google Scholar 

  33. Phillips CL, Yee BJ, Marshall NS, Liu PY, Sullivan DR, Grunstein RR (2011) Continuous positive airway pressure reduces postprandial lipidemia in obstructive sleep apnea: a randomized, placebo-controlled crossover trial. Am J Respir Crit Care Med 184:355–361

    Article  PubMed  Google Scholar 

  34. Drager LF, Li J, Shin M-K, Reinke C, Aggarwal NR, Jun JC, Bevans-Fonti S, Sztalryd C, O’Byrne SM, Kroupa O, Olivecrona G, Blaner WS, Polotsky VY (2012) Intermittent hypoxia inhibits clearance of triglyceride-rich lipoproteins and inactivates adipose lipoprotein lipase in a mouse model of sleep apnoea. Eur Heart J 33:783–790

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  35. Drager LF, Togeiro SM, Polotsky VY, Lorenzi-Filho G (2013) Obstructive sleep apnea: a cardiometabolic risk in obesity and the metabolic syndrome. JACC 62:569–576

    Article  PubMed Central  PubMed  Google Scholar 

  36. Keenan BT, Maislin G, Sunwoo BY, Arnardottir ES, Jackson N, Olafsson I, Juliusson S, Sxhwab RJ, Gislason T, Benediktsdottir B, Pack AI (2014) Obstructive sleep apnoea treatment and fasting lipids: a comparative effectiveness study. Eur Respir J 44:405–414

    Article  CAS  PubMed  Google Scholar 

  37. Weaver TE, Grunstein RR (2008) Adherence to continuous positive airway pressure therapy: the challenge to effective treatment. Proc Am Thorac Soc 5:173–178

    Article  PubMed Central  PubMed  Google Scholar 

  38. National Cholesterol Education Program (NCEP) Expert Panel on Detection (2002) Evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). Circulation 106:3143–3421

    Google Scholar 

  39. Barceló A, Barbé F, de la Peña M, Martinez P, Soriano JB, Piérola J, Agustí AGN (2008) Insulin resistance and daytime sleepiness in patients with sleep apnoea. Thorax 63:946–950

    Article  PubMed  Google Scholar 

  40. Dorkova Z, Petrasova D, Molcanyiova A, Popovnakova M, Tkacova R (2008) Effects of continuous positive airway pressure on cardiovascular risk profile in patients with severe obstructive sleep apnea and metabolic syndrome. Chest 134:686–692

    Article  CAS  PubMed  Google Scholar 

  41. Cuhadaroğlu C, Utkusavaş A, Oztürk L, Salman S, Ece T (2009) Effects of nasal CPAP treatment on insulin resistance, lipid profile, and plasma leptin in sleep apnea. Lung 187:75–81

    Article  PubMed  Google Scholar 

  42. Robinson GV, Pepperell JC, Segal HC, Davies RJ, Stradling JR (2004) Circulating cardiovascular risk factors in obstructive sleep apnoea: data from randomized controlled trials. Thorax 59:777–782

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  43. Comondore VR, Cheema R, Fox J, Butt A, John Mancini GB, Fleetham JA, Ryan CF, Chan S, Ayas NT (2009) The impact of CPAP on cardiovascular biomarkers in minimally symptomatic patients with obstructive sleep apnea: a pilot feasibility randomized crossover trial. Lung 187:17–22

    Article  PubMed  Google Scholar 

  44. Nguyen PK, Katikireddy CK, McConnell MV, Kushida C, Yang PC (2010) Nasal continuous positive airway pressure improves myocardial perfusion reserve and endothelial-dependent vasodilation in patients with obstructive sleep apnea. J Cardiovasc Magn Reson 12:50

    Article  PubMed Central  PubMed  Google Scholar 

  45. Sharma SK, Agrawal S, Damodaran D, Sreenivas V, Kadhiravan T, Lakshmy R, Jagia P, Kumar A (2011) Retraction: CPAP for the metabolic syndrome in patients with obstructive sleep apnea. N Engl J Med 365:2277-2286. N Engl J Med 2013; 369:1770

  46. Newman AB, Nieto FJ, Guidry U, Lind BK, Redline S, Pickering TG, Quan SF, Sleep Heart Health Study Research Group (2001) Relation of sleep-disordered breathing to cardiovascular disease risk factors: The Sleep Heart Health Study. Am J Epidemiol 154:50–59

    Article  CAS  PubMed  Google Scholar 

  47. Tisko R, Sopkova Z, Habalova V, Dorkova Z, Slaba E, Javorsky M, Tkac I, Riha RL, Tkacova R (2014) Effects of apolipoprotein E genotype on serum lipids in obstructive sleep apnoea. Eur Respir J 43:1097–1105

    Article  CAS  PubMed  Google Scholar 

  48. Wang M, Briggs MR (2004) HDL: the metabolism, function, and therapeutic importance. Chem Rev 104:119–137

    Article  CAS  PubMed  Google Scholar 

  49. Van Lenten BJ, Hama SY, de Beer FC, Stafforini DM, McIntyre TM, Prescott SM, La Du BN, Fogelman AM, Navab M (1995) Anti-inflammatory HDL becomes pro-inflammatory during the acute phase response. Loss of protective effect of HDL against LDL oxidation in aortic wall cell cocultures. J Clin Invest 96:2758–2767

    Article  PubMed Central  PubMed  Google Scholar 

  50. Navab M, Hama SY, Hough GP, Subbanagounder G, Reddy ST, Fogelman AM (2001) A cell-free assay for detecting HDL that is dysfunctional in preventing the formation of or inactivating oxidized phospholipids. J Lipid Res 42:1308–1317

    CAS  PubMed  Google Scholar 

  51. Tan KC, Chow WS, Lam JC, Lam B, Wong WK, Tam S, Ip MS (2006) HDL dysfunction in obstructive sleep apnea. Atherosclerosis 184:377–382

    Article  CAS  PubMed  Google Scholar 

  52. Budhiraja R, Parthasarathy S, Drake CL, Roth T, Sharief I, Budhiraja P, Saunders V, Hudgel DW (2007) Early CPAP use identifies subsequent adherence to CPAP therapy. Sleep 30:320–324

    PubMed  Google Scholar 

  53. McArdle N, Devereux G, Heidarnejad H, Engleman HM, Mackay TW, Douglas NJ (1999) Long-term use of CPAP therapy for sleep apnea/hypopnea syndrome. Am J Respir Crit Care Med 159:1108–1114

    Article  CAS  PubMed  Google Scholar 

  54. Barbé F, Mayoralas LR, Duran J, Masa JF, Maimó A, Montserrat JM, Monasterio C, Bosch M, Ladaria A, Rubio M, Rubio R, Medinas M, Hernandez L, Vidal S, Douglas NJ, Agustí AG (2001) Treatment with continuous positive airway pressure is not effective in patients with sleep apnea but no daytime sleepiness. A randomized, controlled trial. Ann Intern Med 134:1015–1023

    Article  PubMed  Google Scholar 

  55. Quan SF, Budhiraja R, Clarke DP, Goodwin JL, Gottlieb DJ, Nichols DA, Simon RD, Smith TW, Walsh JK, Kushida CA (2013) Impact of treatment with continuous positive airway pressure (CPAP) on weight in obstructive sleep apnea. J Clin Sleep Med 9:989–993

    PubMed Central  PubMed  Google Scholar 

  56. Kezirian EJ, Kirisoglu CE, Riley RW, Chang E, Guilleminault C, Powell NB (2008) Resting energy expenditure in adults with sleep disordered breathing. Arch Otolaryngol Head Neck Surg 134:1270–1275

    Article  PubMed  Google Scholar 

  57. Teramoto S, Yamamoto H, Yamaguchi Y, Namba R, Ouchi Y (2005) Obstructive sleep apnea causes systemic inflammation and metabolic syndrome. Chest 127:1074–1075

    Article  PubMed  Google Scholar 

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Acknowledgments

Authors would like to thank participating patients; Luís Azevedo, MD (Cintesis, Faculty of Medicine of the University of Oporto) for the advice on statistical analysis.

Conflict of interests

There is no financial or personal relationship with other people or organization that could inappropriately influence this work.

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Authors and Affiliations

  1. Department of Experimental Biology, Faculdade de Medicina do Porto, Universidade do Porto, Alameda Professor Hernâni Monteiro, 4200-319, Porto, Portugal

    Sandra Rebelo

  2. Department of Pulmonology, Hospital de São João, Alameda Professor Hernâni Monteiro, 4200-319, Porto, Portugal

    Marta Drummond & José Agostinho Marques

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  1. Sandra Rebelo
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  2. Marta Drummond
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Correspondence to Sandra Rebelo.

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Rebelo, S., Drummond, M. & Marques, J.A. Lipid profile after long-term APAP in OSA patients. Sleep Breath 19, 931–937 (2015). https://doi.org/10.1007/s11325-014-1095-5

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  • DOI: https://doi.org/10.1007/s11325-014-1095-5

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