Changes in cortisol levels by continuous positive airway pressure in patients with obstructive sleep apnoea: Meta‐analysis of 637 individuals

Ken‐Dror, Gie; Fry, Christopher; Murray, P.; Fluck, David; Han, Thang S.

doi:10.1111/cen.14573

Cited by 13 publications

(11 citation statements)

References 46 publications

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“…In a meta-analysis of 637 participants with OSA, CPAP treatment significantly reduced both plasma and salivary cortisol levels. Individuals undergoing investigation for Cushing’s syndrome would benefit from an initial screening for OSA; the impact of CPAP on cortisol has been debatable because of conflicting findings between studies due to small sample sizes [ 7 ]. The mechanism of correlation between sleep apnea and Cushing’s disease/Cushing’s syndrome have never been investigated; it has been suggested that weight gain and adipose tissue accumulation according to a centripetal pattern in the subcutaneous tissue of the neck can likely lead to the development of obstructive sleep apnea in these patient population.…”

Section: Discussionmentioning

confidence: 99%

Association Between Cushing’s Syndrome and Sleep Apnea: Results From the National Inpatient Sample

Pattipati¹,

Gudavalli²

2022

Cureus

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BackgroundCushing's syndrome is a metabolic disorder related to excess cortisol production. Patients with Cushing's syndrome are at risk for the development of other comorbid medical conditions such as hypertension, diabetes, obesity, and obstructive sleep apnea. Obstructive sleep apnea has been well associated with endocrine disorders such as acromegaly and hypothyroidism. However, its causal association with Cushing's syndrome is still unclear. We utilized a national database to study the prevalence of sleep apnea in Cushing's syndrome. HypothesisWe hypothesized that patients with Cushing's syndrome might have an increased prevalence of sleep apnea. MethodsPatients aged above 18 years from the NIS database between 2017 and 2018 with a diagnosis of Cushing's syndrome and sleep apnea were extracted using the 10th revision of the International Classification of Diseases (ICD-10) codes, with code E24 representing Cushing's syndrome and G47.3 representing sleep apnea. The prevalence of sleep apnea and other comorbid medical conditions were identified using the ICD-10 codes. Logistic regression analysis was performed to examine the association between Cushing's syndrome and sleep apnea. ResultsCushing's syndrome was prevalent in 0.037% (2,248 of 6,023,852) of all inpatient hospitalizations. Patients with Cushing's syndrome were slightly younger (mean age: 54 ± 16 versus 58 ± 20) and more likely to be females (76%, 1,715 out of 2,248) and had higher rates of sleep apnea (21.9% versus 8.7%, p < 0.000) and obstructive sleep apnea (OSA) (18.6% versus 7.2%, p < 0.000) when compared to the general population. Cushing's syndrome is independently associated with sleep apnea, with an unadjusted odds ratio (OR) of 2.94 (p < 0.01) and an adjusted odds ratio (aOR) of 1.79 after adjusting for demographics and other risk factors for sleep apnea and comorbid medical conditions (p < 0.01). ConclusionsCushing's syndrome is associated with increased prevalence of sleep apnea and independent predictor of sleep apnea. Further prospective studies are recommended to validate the causal association. The high prevalence and coexistence of both these disorders validate screening for sleep apnea as part of routine workup in patients with Cushing's syndrome and vice versa.

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Section: Discussionmentioning

confidence: 99%

Association Between Cushing’s Syndrome and Sleep Apnea: Results From the National Inpatient Sample

Pattipati¹,

Gudavalli²

2022

Cureus

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“…For example, although there was no significant difference in the BMI within the two groups, some of the patients in the unsuppressed PRA group exhbited a higher BMI that could lead to sleep apnea syndrome (SAS). SAS could, in turn, lead to the elevation of PRA and cortisol levels via dysregulation of the renin-angiotensin-aldosterone system through altered sympathetic nervous system activation [ 56 , 57 ]. Actually, some patients in the unsuppressed PRA group showed a high apnea-hypo index, as shown in S1 Table .…”

Section: Discussionmentioning

confidence: 99%

Characteristics of aldosterone-producing adenomas in patients without plasma renin activity suppression

et al. 2022

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Primary aldosteronism (PA) usually accompanies suppressed plasma renin activity (PRA) through a negative feedback mechanism. While some cases of PA with unsuppressed PRA were reported, there have been no studies about the characteristics of PA with unsuppressed PRA; thus, these characteristics were examined herein. Nine patients with unsuppressed PRA and 86 patients with suppressed PRA were examined. All patients underwent segmental adrenal venous sampling (sAVS) and adrenalectomy, and were pathologically confirmed to have cytochrome P450 11B2 (CYP11B2)-positive aldosterone-producing adenoma according to international histopathology consensus criteria. Unsuppressed and suppressed PRA were defined as PRA levels of > 1.0 and ≤ 1.0 ng/mL/hr, respectively, in multiple blood samples obtained in the resting position. The unsuppressed PRA group had higher morning cortisol levels (12.6 [8.5, 13.5] vs. 8.5 [7.1, 11.0] μg/dL, P = 0.03) and higher cortisol levels after a 1 mg dexamethasone suppression test (DST) (2.2 [1.6, 2.5] vs. 1.3 [1.0, 1.9] μ g/dL, P = 0.004) than the suppressed PRA group. The unsuppressed PRA group also showed higher aldosterone levels on the non-surgical side during sAVS (P = 0.02 before adrenocorticotropic hormone (ACTH) stimulation, P = 0.002 after ACTH stimulation), a higher intensity of CYP17 expression in the resected adrenal gland (P = 0.02), and a lower clinical complete success rate 1 year after surgery (P = 0.04) compared with those in the suppressed PRA group. These findings suggest that PA should not be ruled out by unsuppressed PRA among patients with hypertension, particularly when their cortisol levels remain unsuppressed in the 1 mg DST. Meanwhile, it should be acknowledged that patients with unsuppressed PRA have higher aldosterone levels on the non-surgical side, and a lower likelihood of postoperative complete clinical success is to be expected.

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“…Nevertheless, it is a plausible that CPAP has no effect on circulating testosterone levels, which if true would point to irreversible neuroendocrine changes to the testicular axis arising from longstanding intermittent hypoxia – irreversible changes that are not found in the adrenal axis. By comparison, a meta-analysis of 22 studies (of which 6 were randomized controlled trials) was sufficiently powered to conclude that CPAP decreases cortisol [ 122 ]. More studies, including randomized sham-controlled studies utilizing repetitive overnight or 24-h blood sampling and modern mathematical deconvolution techniques that better discriminate subtle regulatory changes are needed to finally resolve this issue.…”

Section: Obstructive Sleep Apneamentioning

confidence: 99%

Sleep, testosterone and cortisol balance, and ageing men

Liu

Reddy

2022

Rev Endocr Metab Disord

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Sleep serves important biological functions, and influences health and longevity through endocrine and metabolic related systems. Sleep debt, circadian misalignment and sleep disruption from obstructive sleep apnea is widespread in modern society and accumulates with life because recovery sleep is not completely restorative. Accumulated disordered sleep throughout life impacts the ageing process and the development of age-related diseases. When epidemiological and interventional studies are considered collectively, sleep loss and lower sleep duration are associated with lower morning, afternoon and 24-h testosterone; as well as higher afternoon, but not morning or 24-h cortisol. These reciprocal changes imbalances anabolic-catabolic signaling because testosterone and cortisol are respectively the main anabolic and catabolic signals in man. Fixing testosterone-cortisol balance by means of a novel dual-hormone clamp mitigates the induction of insulin resistance by sleep restriction and provided the first proof-of-concept that the metabolic harm from sleep loss can be ameliorated by approaches that do not require sleeping more. Obstructive sleep apnea is associated with lower testosterone, even after controlling for age and obesity whereas the conclusion that continuous positive airway pressure therapy has no effect on testosterone is premature because available studies are underpowered and better-quality studies suggest otherwise. High dose testosterone therapy induces OSA, but more physiological dosing may not; and this effect may be transient or may dissipate with longer term therapy. Studies investigating the origin of the diurnal testosterone rhythm, the effect of circadian misalignment on testosterone-cortisol balance, and methods to mitigate metabolic harm, are required.

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Changes in cortisol levels by continuous positive airway pressure in patients with obstructive sleep apnoea: Meta‐analysis of 637 individuals

Cited by 13 publications

References 46 publications

Association Between Cushing’s Syndrome and Sleep Apnea: Results From the National Inpatient Sample

Association Between Cushing’s Syndrome and Sleep Apnea: Results From the National Inpatient Sample

Characteristics of aldosterone-producing adenomas in patients without plasma renin activity suppression

Sleep, testosterone and cortisol balance, and ageing men

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