Cardiovascular Events in Moderately to Severely Obese Obstructive Sleep Apnea Patients on Positive Airway Pressure Therapy

Abstract

Background: In moderately to severely obese patients with obstructive sleep apnea (OSA), the effects of long-term positive airway pressure (PAP) treatment on cardiovascular risk are poorly defined. Purpose: To assess the effect of continuous positive airway pressure (CPAP) or noninvasive ventilation (NIV) on the occurrence of cardiovascular events in obese OSA patients. Methods: We performed a noninterventional observational study in obese OSA patients recruited between 2007 and 2010 at the Sleep Center, University of Grenoble, treated with CPAP or NIV, and followed for 5.6 years by a single home care provider. Baseline clinical characteristics, blood chemistry, and respiratory and vascular function were assessed. Incident cardiovascular events were investigated by phone interviews. Results: A total of 103 patients (55 men, 48 women; age and body mass index [BMI] at diagnosis 54.1 ± 10.5 years and 40.3 ± 5.5, respectively [mean ± standard deviation]; CPAP: n = 75; NIV: n = 28) agreed to participate in the study. Grade I, II, and III obesity occurred in 17.5, 33.0, and 49.5% of the sample, respectively. In patients using PAP treatment (n = 69), the mean nightly use was 6.3 ± 2.4 h. Thirty-one patients stopped PAP treatment during follow-up. Three patients on NIV died. Nonfatal cardiovascular events (n = 27) occurred in 19 patients, who were older and showed higher number of comorbidities and triglyceride levels than patients without events. In the patients who interrupted treatment, the event rate was high and increased with the number of comorbidities, while BMI at baseline did not predict events. Conclusions: The study suggests that regular PAP treatment may be associated with protection against cardiovascular risk in obese OSA patients, especially in the presence of multiple comorbidities.

Obstructive sleep apnea and comorbidities: a dangerous liaison

“…In patients aged >50 years, protective effects of CPAP treatment were shown only in patients with comorbidities [12]. In patients with moderate-severe obesity and OSA, treatment with CPAP or noninvasive ventilation was associated with fewer cardiovascular events only in patients with a high number of comorbidities [13]. The protective effect of CPAP might be larger in males than females with OSA [14, 15].…”

Should mild obstructive sleep apnoea be treated? A systematic review from the standpoint of disease progression

“…The ceiling effect is described in fields such as cardiology (effect of exercise on reducing hypertension risk attenuates after reaching a certain level of intensity or frequency) 37 and neurology (effect of stroke severity on motor recovery outcomes). 38 In the context The Journal of Laryngology & Otology of OSA, the ceiling effect has been reported in the effect of extreme obesity on cardiovascular risk, 39 and quality of life outcomes in low OSA risk patients. 40 Our findings showed that patients with lower BMI at diagnosis tend to be at higher risk of more rapid OSA progression.…”

REM-OSA as a Tool to Understand Both the Architecture of Sleep and Pathogenesis of Sleep Apnea—Literature Review

“…The gold standard treatment in OSA is continuous positive airways pressure therapy, as it offers the greatest efficiency and protective effect in terms of cardiovascular comorbidities [ 141 , 142 , 143 ]. Despite its effectiveness in reducing the outcomes of OSA, it is characterized by poor adherence in the general population of OSA patients [ 144 ].…”