Background Obstructive sleep apnea (OSA) is associated with increased cardiovascular morbidity and mortality. Recent data suggest that OSA is independently associated with the cardiovascular risk factors that comprise metabolic syndrome. Continuous positive airway pressure treatment has been shown to affect multiple components, which have been associated with improved cardiovascular risk profile. No studies have been done that evaluated the effects of continuous positive airway pressure on the plasma lipid levels and waist circumference in patients with obstructive sleep apnea.
Methods Prospective observational study on consecutive patients referred to UCSF-Fresno Sleep Disorders Clinic and diagnosed with OSA by overnight polysomnographic evaluation and requiring CPAP treatment. The 12-hour fasting lipid level (total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides) was measured within 6 months before the CPAP treatment and at least 6 months after CPAP. Patients on lipid-lowering medications were included if the dose of the medication was not changed during the CPAP treatment. Presence of diabetes mellitus, hypertension, coronary artery disease, body mass index (BMI), and waist circumference before and after CPAP treatment were recorded. Compliance with CPAP treatment (as daily use) was obtained during a telephone interview.
Results A total of 268 patients have been enrolled in the study; 63 were excluded for incomplete data. The data collection was completed for 80 patients out of 205 who had at least 6 months of CPAP treatment. Thirty-seven patients were removed from final analysis due to changes in their lipid lowering medications. A remaining 43 patients were divided in two groups: 21 compliant with CPAP and 22 (51%) noncompliant with CPAP (control group). The demographics of the groups were similar. The proportion of patients with diabetes was 10% in the CPAP users group and 5% in the control group, with hypertension was 43% and 59%, and with coronary artery disease was 5% in both groups. The follow-up data revealed that compliant patients on CPAP had a nonsignificant decrease in BMI, waist circumference, and LDL and a nonsignificant increase in total cholesterol and triglycerides and a decrease in HDL when compared with controls. Age, sex, and ethnicity had no impact on lipid levels.
Conclusions In the preliminary analysis of the data on 43 patients, the compliance with CPAP treatment recommendation was 49%. There is no significant and consistent association of CPAP and lipid levels or metabolic syndrome parameters in these patients at 6 months.
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