Effects of Nasal CPAP Treatment on Insulin Resistance, Lipid Profile, and Plasma Leptin in Sleep Apnea
- 422 Downloads
Obstructive sleep apnea has been linked with metabolic syndrome characterized by dyslipidemia, dyscoagulation, hypertension, and diabetes mellitus type 2 and their cardiovascular consequences. This study was designed to determine the effects of 8 weeks of therapy with continuous positive airway pressure (CPAP) on insulin resistance, glucose, and lipid profile, and the relationship between leptin and insulin-resistance parameters in patients with moderate-to-severe obstructive sleep apnea.
In 44 patients, serum cholesterol, triglycerides, high-density lipoprotein, low-density lipoprotein, very low-density lipoprotein, leptin, and insulin parameters were measured at baseline and after 8 weeks of CPAP. Insulin resistance index was based on the homeostasis model assessment (HOMA-IR) method. Insulin sensitivity (HOMA-S) and insulin secretion capacity (HOMA-β) also were calculated. Thirteen patients were excluded from statistical analyses due to noncompliant CPAP usage (<4 h night−1).
In 31 patients who used CPAP for ≥4 h night−1, CPAP therapy reduced total cholesterol (P < 0.05), low-density lipoprotein (P < 0.05), and leptin (P < 0.05). Circulating leptin levels showed significant correlation with both HOMA-S and HOMA-IR at baseline and follow-up (P = 0.03 for all). In addition, there was no correlation between HOMA-IR and the severity of sleep apnea, which was shown by apnea-hypopnea index.
In patients with moderate-to-severe obstructive sleep apnea, compliant CPAP usage may improve insulin secretion capacity, reduce leptin, total cholesterol, and low-density lipoprotein levels. Leptin showed significant relationship with insulin resistance, and this relationship remained after 8 weeks of CPAP therapy.
KeywordsSleep apnea Leptin Insulin resistance Continuous positive airway pressure Lipid
- 5.Ünal M, Öztürk L (2005) The effect of body mass index on the severity of obstructive sleep apnea. In: Ferrera LA (ed) Body mass index and health. Nova Science Publishers, New York, pp 81–96Google Scholar
- 7.Vgontzas AN, Papanicolaou DA, Bixler EO, Hopper K, Lotsikas A, Lin HM, Kales A, Chrousos GP (2000) Sleep apnea and daytime sleepiness and fatigue: relation to visceral obesity, insulin resistance, and hypercytokinemia. J Clin Endocrinol Metab 85:1151–1158. doi: 10.1210/jc.85.3.1151 PubMedCrossRefGoogle Scholar
- 8.American Diabetes Association (1998) Consensus development conference on insulin resistance. Diabetes Care 21:1–5Google Scholar
- 15.Chin K, Shimizu K, Nakamura T, Narai N, Masuzaki H, Ogawa Y, Mishima M, Nakamura T, Nakao K, Ohi M (1999) Changes in intra-abdominal visceral fat and serum leptin levels in patients with obstructive sleep apnea syndrome following nasal continuous positive airway pressure therapy. Circulation 100:706–712PubMedGoogle Scholar
- 21.Rechtschaffen A, Kales AA (1968) A manual of standardized terminology, techniques and scoring for sleep stages of human subjects. National Institutes of Health publication No.204. Government Printing Office, Washington, DCGoogle Scholar
- 30.Harsch IA, Konturek PC, Koebnick C, Kuehlein PP, Fuchs FS, Schahin SP, Wiest GH, Hahn EG, Lohmann T, Ficker JH (2003) Leptin and ghrelin levels in patients with obstructive sleep apnoea: effect of CPAP treatment. Eur Respir J 22:251–257. doi: 10.1183/09031936.03.00010103 PubMedCrossRefGoogle Scholar
- 35.Wallace TM, Levy JC, Matthews DR (2004) Use and abuse of HOMA modeling. Diabetes Care 21:568–576Google Scholar