OSA is independently associated with an increase in the cardiovascular risk factors that comprise the metabolic syndrome and its overall prevalence. This may help explain the increased cardiovascular morbidity and mortality associated with this condition.

Obstructive sleep apnoea is associated with increased blood pressure and other features of the metabolic syndrome. The aim of the present study was to determine the relative effectiveness of continuous positive airway pressure (CPAP) in modifying these outcomes.A randomised placebo-controlled blinded crossover trial comparing cardiovascular and metabolic outcomes after 6 weeks of therapeutic and sham CPAP was performed in 34 CPAPnaïve patients (mean¡SD body mass and respiratory disturbance indices were 36.1¡7.6 and 39.7¡13.8, respectively).Mean waking systolic and diastolic blood pressure fell by 6.7 and 4.9 mmHg, respectively, when compared with sham CPAP. No change was observed in glucose, lipids, insulin resistance or the proportion of patients with metabolic syndrome. In CPAP-compliant patients the fall in blood pressure was greater and the baroreceptor sensitivity improved significantly but no metabolic variable changed.In obese Caucasians with untreated obstructive sleep apnoea, continuous positive airways pressure can improve baroreceptor responsiveness and reduce waking blood pressure within 6 weeks, but this treatment period was insufficient to modify insulin resistance or change the metabolic profile. The mechanisms underlying this difference in the time course of blood pressure and metabolic response to continuous positive airway pressure in obstructive sleep apnoea requires further exploration.

OBJECTIVE: This study investigated whether medically significant obesity (body mass index > 30 kg=m 2 ) is recognised effectively in hospital outpatient departments and how those identified as obese are subsequently managed. DESIGN: A retrospective analysis of patients' hospital records (rheumatology n ¼ 108, cardiology n ¼ 257, orthopaedic n ¼ 250) established the reported prevalence of obesity and subsequent referral patterns. In addition, BMI was measured prospectively on a separate cohort (rheumatology n ¼ 188, cardiology n ¼ 203, orthopaedic n ¼ 179) to determine the true prevalence. RESULTS: Generally, obesity management appeared minimal and inconsistent. Retrospective analysis revealed an apparently low rate of obesity (4% cardiology, 5% rheumatology and 3% orthopaedics), whilst the true prevalence was found to be 30% for cardiology, 25.1% for orthopaedics and 20.2% for rheumatology. Although this appears to show a large disparity between the apparent and the true prevalence, it is impossible to establish precisely the degree of under-estimation, as the lack of height measurements (14% only) in the retrospective sample affects the reliability of the apparent prevalence. Further comparison with the general population showed obesity to be particularly common in men attending cardiology clinics. CONCLUSION: An outpatient clinic consultation could be a useful starting point for integrating obesity and disease management, by helping to identify obesity, initiate appropriate referrals and assist in obesity education.