Cardiometabolic changes after continuous positive airway pressure for obstructive sleep apnoea: a randomised sham-controlled study
Cardiometabolic changes after continuous positive airway pressure for obstructive sleep apnoea: a randomised sham-controlled study
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DOI：
10.1136/thoraxjnl-2011-201420
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发表时间：
2012-12-01
期刊：
影响因子：
10
通讯作者：
Liu, Peter Y.
中科院分区：
文献类型：
--
作者：
Hoyos, Camilla M.;Killick, Roo;Liu, Peter Y.
基本原理和目标 胰岛素敏感性受损 (ISx)、内脏腹部脂肪 (VAF) 和肝脏脂肪增加都是代谢综合征的核心组成部分，也是患有阻塞性睡眠呼吸暂停 (OSA) 男性的特征。尚未以随机假对照方式系统地研究 OSA 男性持续气道正压通气 (CPAP) 治疗中观察到的这些变化的可逆性。方法 65 名未接受过 CPAP 且患有中度至重度 OSA 的非糖尿病男性（年龄 = 49 +/- 12 岁，呼吸暂停低通气指数 (AHI) = 39.9 +/- 17.7 事件/小时，体重指数 = 31.3 +/- 5.2 kg/m(2)) 被随机分配接受真实 (n=34) 或假 (n=31) CPAP 治疗，为期 12 周。第 12 周时，所有受试者均接受额外 12 周的真正 CPAP 治疗。测量和主要结果 主要结果是第 12 周时 VAF、ISx 和肝脏脂肪相对于基线的变化。其他代谢结果包括处置指数、总脂肪、血液瘦素和脂联素浓度的变化。 12 周后，与假手术相比，CPAP 治疗组的 AHI 降低了 33 次/小时（95% CI-43.9 至 -22.2，p < 0.0001）。 12周时，VAF（-13.0 cm(3)、-42.4至16.2，p=0.37）、ISx（-0.13（min（-1））（mu U/ml））（-1）、-0.40至0.14，p=0.33）、肝脏脂肪（-0.5 cm（3）、-3.8至2.7、 p=0.74）或任何其他心脏代谢参数。 24 周时，ISx (3.2x10(4) (min(-1))(mu U/ml))(-1)、0.9x10(4) 至 6.0x10(4)，p=0.009），但不是 VAF（-1.4 cm(3)、-19.2 至 16.4，p=0.87）或肝脏脂肪（-0.2 Hounsfield 单位， -2.4 至 2.0，p=0.83) 与整个研究组的基线相比有所改善。结论 单独使用 CPAP 无法实现减少 OSA 男性内脏肥胖，可能需要减肥干预措施。 CPAP 对 ISx 等其他心脏代谢标志物的长期影响需要进一步研究以充分检查时间依赖性。
Rationale and objectives Impaired insulin sensitivity (ISx), increased visceral abdominal fat (VAF) and liver fat are all central components of the metabolic syndrome and characteristics of men with obstructive sleep apnoea (OSA). The reversibility of these observed changes with continuous positive airway pressure (CPAP) treatment in men with OSA has not been systematically studied in a randomised sham-controlled fashion.Methods 65 men without diabetes who were CPAP naive and had moderate to severe OSA (age=49 +/- 12 years, apnoea hypopnoea index (AHI)=39.9 +/- 17.7 events/h, body mass index=31.3 +/- 5.2 kg/m(2)) were randomised to receive either real (n=34) or sham (n=31) CPAP for 12 weeks. At 12 weeks, all subjects received real CPAP for an additional 12 weeks.Measurements and main results Main outcomes were the change at week 12 from baseline in VAF, ISx and liver fat. Other metabolic outcomes were changes in the disposition index, total fat, and blood leptin and adiponectin concentrations. The AHI was lower on CPAP compared with sham by 33 events/h (95% CI-43.9 to -22.2, p < 0.0001) after 12 weeks. There were no between-group differences at 12 weeks in VAF (-13.0 cm(3), -42.4 to 16.2, p=0.37), ISx (-0.13 (min(-1))(mu U/ml))(-1), -0.40 to 0.14, p=0.33), liver fat (-0.5 cm(3), -3.8 to 2.7, p=0.74) or any other cardiometabolic parameter. At 24 weeks, ISx (3.2x10(4) (min(-1))(mu U/ml))(-1), 0.9x10(4) to 6.0x10(4), p=0.009), but not VAF (-1.4 cm(3), -19.2 to 16.4, p=0.87) or liver fat (-0.2 Hounsfield units, -2.4 to 2.0, p=0.83) were improved compared with baseline in the whole study group.Conclusion Reducing visceral adiposity in men with OSA cannot be achieved with CPAP alone and is likely to require weight-loss interventions. Longer-term effects of CPAP on other cardiometabolic markers such as ISx require further investigation to fully examine time dependencies.