Effects of Continuous Positive Airway Pressure on Cardiovascular Risk Profile in Patients With Severe Obstructive Sleep Apnea and Metabolic Syndrome
Effects of Continuous Positive Airway Pressure on Cardiovascular Risk Profile in Patients With Severe Obstructive Sleep Apnea and Metabolic Syndrome
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DOI：
10.1378/chest.08-0556
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发表时间：
2008-10-01
期刊：
影响因子：
9.6
通讯作者：
Tkacova, Ruzena
中科院分区：
文献类型：
--
作者：
Dorkova, Zuzana;Petrasova, Darina;Tkacova, Ruzena
背景资料：阻塞性睡眠呼吸暂停（OSA）患者动脉粥样硬化发病率和死亡率的增加与动脉高血压、胰岛素抵抗、全身炎症和氧化应激有关。我们的目的是确定8周持续气道正压通气（CPAP）治疗对重度OSA和代谢综合征患者的血糖和血脂、全身炎症、氧化应激和全球心血管疾病（CVD）风险的影响。方法：在32例患者中，血清胆固醇、甘油三酯、高密度脂蛋白胆固醇、纤维蛋白原、载脂蛋白A-I、载脂蛋白B（Apo B）、在基线和CPAP治疗8周后测定高敏C反应蛋白、白细胞介素-6、肿瘤坏死因子（TNF）-α、瘦素、丙二醛（MDA）和红细胞谷胱甘肽过氧化物酶（GPx）活性。胰岛素抵抗指数（稳态模型评估[HOMA-IR]）基于稳态模型评估方法，使用多变量风险因子算法计算CVD风险。在使用CPAP>= 4 h/night的患者中（n = 16），CPAP治疗降低了收缩压和舒张压（分别为p = 0.001和p = 0.006），总胆固醇（p = 0.002），载脂蛋白B（p = 0.009），HOMA-IR（p = 0.031），MDA（p = 0.004）和TNF-α（p = 0.037），红细胞GPx活性增加（p = 0.015），与全球CVD风险降低相关（从18.8 +/-9.8%降至13.9 +/-9.7%，p = 0.001）。使用CPAP < 4 h/夜的患者无显著变化。面罩漏气是CPAP治疗依从性的最强预测因子。结论：在重度OSA和代谢综合征患者中，良好的CPAP依从性可改善胰岛素敏感性，减少全身炎症和氧化应激，并降低全球CVD风险。试验注册：Clinicaltrials.gov标识符：NCT 00635674。（CHEST 2008; 134：686-692）
Background: The increased risk of atherosclerotic morbidity and mortality in patients with obstructive sleep apnea (OSA) has been linked to arterial hypertension, insulin resistance, systemic inflammation, and oxidative stress. We aimed to determine the effects of 8 weeks of therapy with continuous positive airway pressure (CPAP) on glucose and lipid profile, systemic inflammation, oxidative stress, and global cardiovascular disease (CVD) risk in patients with severe OSA and metabolic syndrome.Methods: In 32 patients, serum cholesterol, triglycerides, high-density lipoprotein cholesterol, fibrinogen, apolipoprotein A-I, apolipoprotein B (ApoB), high-sensitivity C-reactive protein, interleukin-6, tumor necrosis factor (TNF)-alpha, leptin, malondialdehyde (MDA), and crythrocytic glutathione peroxidase (GPx) activity were measured at baseline and after 8 weeks of CPAP. The insulin resistance index (homeostasis model assessment [HOMA-IR]) was based on the homeostasis model assessment method, the CVD risk was calculated using the multivariable risk factor algorithm.Results: In patients who used CPAP for >= 4 h/night (n = 16), CPAP therapy reduced systolic BP and diastolic BP (p = 0.001 and p = 0.006, respectively), total cholesterol (p = 0.002), ApoB (p = 0.009), HOMA-IR (p = 0.031), MDA (p = 0.004), and TNF-alpha (p = 0.037), and increased erythrocytic GPx activity (p = 0.015), in association with reductions in the global CVD risk (from 18.8 +/- 9.8 to 13.9 +/- 9.7%, p = 0.001). No significant changes were seen in patients who used CPAP for < 4 h/night. Mask leak was the strongest predictor of compliance with CPAP therapy.Conclusions: In Patients with severe OSA and metabolic syndrome, good compliance to CPAP may improve insulin sensitivity, reduce systemic inflammation and oxidative stress, and reduce the global CVD risk.Trial registration: Clinicaltrials.gov Identifier: NCT00635674. (CHEST 2008; 134:686-692)