Effect of CPAP on Endothelial Function in Subjects With Obstructive Sleep Apnea: A Meta-Analysis

Abstract

Obstructive sleep apnea (OSA) is related to endothelial dysfunction. CPAP is the first-line treatment for OSA. We conducted a meta-analysis to evaluate the effect of CPAP on endothelial function in subjects with OSA. The PubMed, Embase, and Cochrane Library databases were searched. The overall effects were measured by the weighted mean difference with a 95% CI. Subgroup and meta-regression analyses were used to explore the sources of between-study heterogeneity. Eleven studies were eligible for the meta-analysis. A random-effects model revealed that CPAP significantly improved endothelial function as assessed by flow-mediated dilation (weighted mean difference of 2.92, 95% CI 2.21-3.63, P < .001), whereas there was no significant improvement in endothelial function in response to nitroglycerin-mediated dilation (weighted mean difference of 0.90, 95% CI ؊1.63 to 3.43, P ‫؍‬ .48). Age, sex, CPAP compliance and duration, and sleep-related variables had no effect on reduction in arterial stiffness after CPAP. Sensitivity analyses indicated that the protective effect of CPAP on endothelial function was robust. CPAP significantly improved flow-mediated dilation in subjects with OSA. Long-term randomized controlled trials with larger sample sizes are needed to confirm the positive effect of CPAP on endothelial function in subjects with OSA.

Cardiorespiratory interaction with continuous positive airway pressure

“…Interestingly, these studies also detected a reduction in apoptotic endothelial cells, which are an ex vivo marker of vascular damage, following CPAP therapy; hypothetically, this could indicate a link between OSA and vascular dysfunction through endothelial cell apoptosis (85). A recent meta-analysis showed a significant improvement of endothelial function, as assessed by FMD, in subjects with OSA after at least one month of CPAP treatment (86). In order to better understand the independent impact of CPAP on endothelial function, studies including larger populations and long-term follow up of CPAP use as well as trials investigating the effect of other conventional cardiovascular risk factors, beside OSA, on vascular function would be useful.…”

Which Is the Ideal Marker for Early Atherosclerosis in Obstructive Sleep Apnea (OSA) – Carotid Intima-Media Thickness or Mean Platelet Volume?

“…The existence of endothelial dysfunction and cardiovascular risk in patients with OSA has been supported by many studies [1–6,27]. During the last decade, IMT has been a frequently investigated parameter for the determination of subclinical atherosclerosis in OSA patients.…”

Beneficial Effects of Continuous Positive Airway Pressure Treatment in Obstructive Sleep Apnoea: The Evidence

“…Obstructive sleep apnoea is associated with reduced endothelial cell function, decreased flow-mediated dilation, and increased arterial stiffness, as measured by carotid-femoral pulse wave velocity, or Augmentation Index (AI) 81 . Two recent meta-analyses reported evidence for a positive effect of CPAP treatment in restoring endothelial function 82,83 . However only flow-mediated dilation improved, while nitroglycerin-induced dilation was unchanged after CPAP treatment 82 .…”

“…Two recent meta-analyses reported evidence for a positive effect of CPAP treatment in restoring endothelial function 82,83 . However only flow-mediated dilation improved, while nitroglycerin-induced dilation was unchanged after CPAP treatment 82 .…”