Beneficial effect of continuous positive airway pressure on lipid profiles in obstructive sleep apnea: a meta-analysis

Abstract

PurposeDyslipidemia is considered as one mechanism causing cardiovascular sequelae in obstructive sleep apnea (OSA). Continuous positive airway pressure (CPAP) can reduce cardiovascular morbidities but its effect on lipid profiles is inconclusive. This study aimed to investigate the effects of CPAP on lipid profiles by a meta-analysis of the existing randomized controlled trials.MethodsStudies were retrieved from MEDLINE/PubMed, EMBASE, CENTRAL, commercial websites, and article references up to August 2013 following the protocols (PROSPERO CRD42012002636). Randomized controlled trials investigating the CPAP effects on changes in lipid profiles in adult patients with OSA were included. Two independent researchers extracted relevant data in duplicate. The pooled effect was analyzed by fixed-effect generic inverse variance, and the heterogeneity was assessed using the I2 statistic.ResultsSix trials with 348 patients and 351 controls were included. CPAP significantly lowered total cholesterol (mean, −6.23 mg/dl; 95% CI, −8.73 to –3.73; I2, 0 %; p < 0.001), triglyceride (mean, −12.60 mg/dl; 95% CI, −18.80 to −6.41; I2, 25 %; p < 0.001), and high-density lipoprotein (mean, −1.05 mg/dl; 95% CI, −1.69 to −0.40; I2, 0 %; p = 0.001), but not low-density lipoprotein (mean, −1.01 mg/dl; 95% CI, −5.04 to 3.02; I2, 0 %; p = 0.62). The lipid-lowering effects were homogeneous across the studies. By subgroup analysis, the reductions of lipid profiles were associated with the cross-over design, subtherapeutic CPAP as placebo, enrolled patients with moderate-to-severe OSA or daytime sleepiness, and CPAP treatment with short-term duration or good compliance.ConclusionsThis meta-analysis validates the observation that CPAP can reduce lipid profiles in patients with OSA.Electronic supplementary materialThe online version of this article (doi:10.1007/s11325-014-1082-x) contains supplementary material, which is available to authorized users.

Sleep apnea: An overlooked cause of lipotoxicity?

“…CPAP use may improve liver enzymes and liver fat content [78, 79] but was without effect in other studies [80, 81]. With regard to plasma lipids, a meta-analysis reported that CPAP modestly reduced cholesterol and triglycerides in association with reduced autonomic activity [82]. Skeletal muscle accounts for at least 75% of insulin-mediated glucose disposal [83], and is the most studied site of fatty acid-induced IR.…”

Effect of continuous positive airway pressure on blood pressure and metabolic profile in women with sleep apnoea

“…One very recent meta-analysis of seven studies with a total of 794 patients reported that all the trials predominantly recruited male patients, with a mean percentage of 74% male [12]. Similarly, the effect of CPAP on glucose and lipid metabolism has also been assessed in cohorts in which women usually accounted for <30-40% of the whole sample [14,[27][28][29][30]. Given that OSA differs between women and men, it cannot be taken for granted that the findings obtained in males can be translated to women.…”

Cardiovascular and Metabolic Impairment in Patients With Obstructive Sleep Apnea

“…В исследованиях, посвящённых воздействию СРАР-терапии на инсулин резистент-ность и липидный профиль, зарегистрированы про-тиворечивые результаты. Выбор режимов вентиля-ционной поддержки, сроков её проведения и разра-ботка алгоритмов комплексного лечения пациентов ОАС с метаболическим синдромом требуют даль-нейшего изучения [51].…”