Continuous Positive Airway Pressure Treatment Increases Serum Vitamin D Levels in Male Patients with Obstructive Sleep Apnea

Abstract

BRIEF SUMMARYCurrent Knowledge/Study Rationale: Vitamin D not only participates in bone metabolism and regulates calcium homeostasis, but also has pleiotropic effects, modulating numerous metabolic processes. Considering that patients with obstructive sleep apnea (OSA) suffer from vitamin D defi ciency and show high serum parathyroid hormone (PTH) levels, we tested the effects of short-term continuous positive airway pressure (CPAP) on serum vitamin D and PTH levels. Study Impact: These fi ndings suggest that short-term CPAP therapy in male patients with OSA determines an increase of serum vitamin D levels. Therefore, the current study provides evidence that OSA seems to be an etiopathogenetic factor involved in vitamin D defi ciency, which may recover after CPAP therapy in male patients. Study Objective:Recent studies report a link between obstructive sleep apnea (OSA) syndrome, low vitamin D levels, and high parathyroid hormone (PTH) concentrations. The aim of the current study is to evaluate the effect of 7-night continuous positive airway pressure (CPAP) therapy on serum vitamin D, PTH, and calcium levels in patients with severe OSA syndrome. Methods: Patients with severe OSA were enrolled into the study and compared to control subjects. Patients with OSA underwent CPAP therapy for 7 nights and were consequently divided into responders (OSA-R, mean residual AHI < 5/h) and nonresponders (OSA-nR, mean residual AHI > 5/h). Serum vitamin D, PTH, and calcium levels were measured at baseline in patients with severe OSA (apnea-hypopnea index > 30/h) and control subjects. Patients with OSA underwent a fi nal morning blood sample after 7-night CPAP therapy. Results: We enrolled 90 patients with OSA into the study (65 OSA-R and 25 OSA-nR) compared to 32 control subjects. At baseline, lower vitamin D and higher PTH levels were detected in the OSA group compared to controls. After 7-night CPAP therapy, male OSA-R patients showed a signifi cant increase in vitamin D levels. Conversely, female OSA-R patients did not show the same increase in vitamin D levels. It was also observed that OSA-nR subjects did not show modifi cations of serum markers after nCPAP-therapy. Conclusions:The study demonstrates that short-term nCPAP treatment is able to promote the recovery of vitamin D homeostasis in male patients with OSA. The mediation of sexual hormones in regulating vitamin D is a possible explanation of the lack of recovery of vitamin D homeostasis in female patients with OSA as it often affects postmenopausal women. Keywords: calcium, CPAP, OSA, PTH, vitamin D Citation: Liguori C, Romigi A, Izzi F, Mercuri NB, Cordella A, Tarquini E, Giambrone MP, Marciani MG, Placidi F. Continuous positive airway pressure treatment increases serum vitamin D levels in male patients with obstructive sleep apnea.

The interfaces between vitamin D, sleep and pain

“…Additionally, Goswami and coworkers (2016) found that BMI and neck circumference could be a confounding factor in the association observed between 25OHD serum levels <20 ng/mL and some risk factors for OSA. A further study revealed that the use of continuous positive airway pressure (CPAP), the gold standard for OSA treatment, promoted increased levels of 25OHD (from 19.21 ± 9.45 ng/mL to 21.03 ± 9.50 ng/mL) ( Table 1) in men with OSA after 7 days of CPAP use (Liguori et al 2015). The CPAP therapy was also effective in increasing 25OHD serum concentrations from 16.05 ± 7.74 ng/mL to 25.73 ± 12.91 ng/mL after 1 year of treatment in both obese and non-obese OSA patients (Liguori et al 2016).…”

“…A pilot study assessing Caucasian OSA individuals submitted to cholecalciferol supplementation (4000 IU/ day) during 15 weeks (Kerley et al 2017) showed an increase in 25OHD serum levels in the supplemented group vs placebo (100.8 ± 39.9 nmol/L × 43.0 ± 21.4 nmol/L, respectively), and a decrease in metabolic parameters such as low-density lipoprotein (LDL) and lipoproteinassociated phospholipase A2 (Lp-PLA2). Some subjects from both groups used CPAP, but the data were not controlled, hampering the interpretation about the benefits of the supplementation since there is current evidence that CPAP use can increase 25OHD levels (Liguori et al 2015).…”

Integrating postural and vestibular dimensions to depict impairment in moderate‐to‐severe obstructive sleep apnea syndrome patients

“…The apnea-hypopnia index (AHI) is defined as the ratio between the sum of all apneas (>90% reduction in airflow for >10 s) plus all hypopneas (>30% reduction in airflow >10 s) associated with ≥3% O 2 desaturation (Berry et al, 2012) and time in bed. In addition to AHI, also the following oxygen saturation (SaO 2 ) parameters were ª 2017 European Sleep Research Society measured: mean SaO 2 , lowest SaO 2 , mean SaO 2 desaturation (SaO 2 desat) and oxygen desaturation index (ODI) (number of oxygen desaturation ≥3% episodes per hour) (Liguori et al, 2015).…”

Serum Vitamin D and Parathyroid Hormone Levels in Patients with Obstructive Sleep Apnea Syndrome

“…Doksan ağır OUAS'lı hastanın dahil edildiği bir çalışmada, çalış-mamızın sonuçlarına benzer şekilde OUAS'lı grupta düşük vitamin D ve yüksek PTH düzeyleri saptanmış, yedi günlük CPAP tedavisi alan erkek OUAS'lı olgularda vitamin D düzeylerinde anlamlı bir artış izlenmiştir (20). Çalışmamızda vitamin D düzeylerinin oksijen desatürasyon indeksi ve ortalama oksijen saturasyonu arasın-da anlamlı ilişki bulunması, OUAS'da uyku esnasında tekrarlayan hipoksi ataklarının vitamin D düzeyleri üzerine olumsuz etkisinin olduğunu düşündürmektedir.…”