CPAP, weight loss, or both for obstructive sleep apnea.
CPAP, weight loss, or both for obstructive sleep apnea.
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DOI：
10.1056/nejmoa1306187
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发表时间：
2014-06-12
期刊：
影响因子：
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通讯作者：
Pack AI
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文献类型：
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作者：
Chirinos JA;Gurubhagavatula I;Teff K;Rader DJ;Wadden TA;Townsend R;Foster GD;Maislin G;Saif H;Broderick P;Chittams J;Hanlon AL;Pack AI
肥胖和阻塞性睡眠呼吸暂停往往共存，并与炎症、胰岛素抵抗、血脂异常和高血压有关，但它们与这些异常的因果关系尚不清楚。我们随机分配181例肥胖、中度至重度阻塞性睡眠呼吸暂停、血清c反应蛋白（CRP）水平大于1.0 mg / l的患者接受持续气道正压通气（CPAP）、减肥干预或CPAP加减肥干预的治疗，疗程为24周。我们评估了联合干预对CRP水平（主要终点）、胰岛素敏感性、脂质水平和血压的增量影响。在有随访数据的146名参与者中，那些被分配到减肥组和那些被分配到联合干预组的人的CRP水平、胰岛素抵抗和血清甘油三酯水平都有所下降。在单独接受CPAP的组中没有观察到这些变化。三组的血压都降低了。与减肥或单独CPAP相比，联合干预对CRP水平没有显著的增加作用。联合干预组胰岛素抵抗和血清甘油三酯水平的降低比仅接受CPAP的组更大，但在联合干预组和减肥组之间这些值没有显著差异。在每个方案分析中，包括90名符合预先规定的依从性标准的参与者，联合干预导致收缩压和平均动脉压的降低比单独使用CPAP或减肥更大。在肥胖和阻塞性睡眠呼吸暂停的成年人中，CPAP联合减肥干预并不比单独干预更能降低CRP水平。在二次分析中，体重减轻与CPAP联合使用时，胰岛素抵抗和血清甘油三酯水平增加。此外，与单独干预相比，坚持减肥和CPAP治疗方案可能导致血压的逐渐降低。
Obesity and obstructive sleep apnea tend to coexist and are associated with inflammation, insulin resistance, dyslipidemia, and high blood pressure, but their causal relation to these abnormalities is unclear. We randomly assigned 181 patients with obesity, moderate-to-severe obstructive sleep apnea, and serum levels of C-reactive protein (CRP) greater than 1.0 mg per liter to receive treatment with continuous positive airway pressure (CPAP), a weight-loss intervention, or CPAP plus a weight-loss intervention for 24 weeks. We assessed the incremental effect of the combined interventions over each one alone on the CRP level (the primary end point), insulin sensitivity, lipid levels, and blood pressure. Among the 146 participants for whom there were follow-up data, those assigned to weight loss only and those assigned to the combined interventions had reductions in CRP levels, insulin resistance, and serum triglyceride levels. None of these changes were observed in the group receiving CPAP alone. Blood pressure was reduced in all three groups. No significant incremental effect on CRP levels was found for the combined interventions as compared with either weight loss or CPAP alone. Reductions in insulin resistance and serum triglyceride levels were greater in the combined-intervention group than in the group receiving CPAP only, but there were no significant differences in these values between the combined-intervention group and the weight-loss group. In per-protocol analyses, which included 90 participants who met prespecified criteria for adherence, the combined interventions resulted in a larger reduction in systolic blood pressure and mean arterial pressure than did either CPAP or weight loss alone. In adults with obesity and obstructive sleep apnea, CPAP combined with a weight-loss intervention did not reduce CRP levels more than either intervention alone. In secondary analyses, weight loss provided an incremental reduction in insulin resistance and serum triglyceride levels when combined with CPAP. In addition, adherence to a regimen of weight loss and CPAP may result in incremental reductions in blood pressure as compared with either intervention alone.