Effect of CPAP, Weight Loss, or CPAP Plus Weight Loss on Central Hemodynamics and Arterial Stiffness

Abstract

Obesity and obstructive sleep apnea (OSA) tend to co-exist. Little is known about the effects of OSA, obesity, or their treatment on central aortic pressures and large artery stiffness. We randomized 139 adults with obesity (BMI>30 kg/m2) and moderate-to-severe-OSA to: 1) CPAP therapy (n=45); 2) weight loss (WL) therapy (n=48); or 3) combined CPAP and WL (n=46) for 24 weeks. We assessed the effect of these interventions on central pressures and carotid-femoral pulse wave velocity (CF-PWV; a measure of large artery stiffness), measured with arterial tonometry. Central systolic pressure was reduced significantly only in the combination arm (−7.4 mmHg, 95%CI: −12.5 to −2.4 mmHg; P=0.004), without significant reductions detected in either the weight loss-only (−2.3 mmHg; 95%CI: −7.5 to 3.0, P=0.39) or the CPAP-only (−3.1 mmHg; 95%CI:−8.3 to 2.0, P=0.23) arms. However, none of these interventions significantly changed central pulse pressure, pulse pressure amplification or the central augmentation index. The change in mean arterial pressure (P=0.008) and heart rate (P=0.027) induced by the interventions were significant predictors of the change in CF-PWV. However, after adjustment for mean arterial pressure and heart rate, no significant changes in CF-PWV were observed in any group. In obese subjects with OSA, combination therapy with WL and CPAP is effective in reducing central systolic pressure. However, this effect is largely mediated by changes in mean, rather than central pulse pressure. WL and CPAP, alone or in combination, did not reduce large artery stiffness in this population.

Effects of continuous positive airway pressure treatment on aortic stiffness in patients with resistant hypertension and obstructive sleep apnea: A randomized controlled trial

“…There is a paucity of data regarding the effects of CPAP on arterial stiffness, with few RCTs (Drager et al, 2007;Eskandari, Zou, Grote, Hoff, & Hedner, 2018;Hoyos, Yee, Wong, Grunstein, & Phillips, 2015;Jain et al, 2017;Jones et al, 2013;Kohler et al, 2013Kohler et al, , 2008Litvin et al, 2013;Melehan et al, 2018;Paz y Mar et al, 2016;Phillips, Grunstein, et al, 2013). However, only five RCTs evaluated cf-PWV (Drager et al, 2007;Jain et al, 2017;Jones et al, 2013;Litvin et al, 2013;Paz y Mar et al, 2016), which is the most widely validated reference standard method of measuring central arterial stiffness (Ben-Shlomo et al, 2014;Van Bortel et al, 2012).…”

“…Two of them evaluated only normotensive individuals (Drager et al, 2007;Jones et al, 2013), two evaluated a mixed sample of normotensive and hypertensive subjects (Jain et al, 2017;Paz y Mar et al, 2016) (64% of hypertensive subjects in the first and 37% in the latter study) and one evaluated only hypertensive patients (Litvin et al, 2013). However, from a methodological standpoint, this unique study was severely compromised by the very short period of CPAP treatment (only 3 weeks).…”

“…There is a paucity of data regarding the effects of CPAP on arterial stiffness, with few RCTs (Drager et al, ; Eskandari, Zou, Grote, Hoff, & Hedner, ; Hoyos, Yee, Wong, Grunstein, & Phillips, ; Jain et al, ; Jones et al, ; Kohler et al, , ; Litvin et al, ; Melehan et al, ; Paz y Mar et al, ; Phillips, Grunstein, et al, ). However, only five RCTs evaluated cf‐PWV (Drager et al, ; Jain et al, ; Jones et al, ; Litvin et al, ; Paz y Mar et al, ), which is the most widely validated reference standard method of measuring central arterial stiffness (Ben‐Shlomo et al, ; Van Bortel et al, ). Two of them evaluated only normotensive individuals (Drager et al, ; Jones et al, ), two evaluated a mixed sample of normotensive and hypertensive subjects (Jain et al, ; Paz y Mar et al, ) (64% of hypertensive subjects in the first and 37% in the latter study) and one evaluated only hypertensive patients (Litvin et al, ).…”

“…However, only five RCTs evaluated cf‐PWV (Drager et al, ; Jain et al, ; Jones et al, ; Litvin et al, ; Paz y Mar et al, ), which is the most widely validated reference standard method of measuring central arterial stiffness (Ben‐Shlomo et al, ; Van Bortel et al, ). Two of them evaluated only normotensive individuals (Drager et al, ; Jones et al, ), two evaluated a mixed sample of normotensive and hypertensive subjects (Jain et al, ; Paz y Mar et al, ) (64% of hypertensive subjects in the first and 37% in the latter study) and one evaluated only hypertensive patients (Litvin et al, ). However, from a methodological standpoint, this unique study was severely compromised by the very short period of CPAP treatment (only 3 weeks).…”

“…Arterial stiffness, especially central aortic stiffness measured by carotid-femoral pulse wave velocity (cf-PWV), is a potent cardiovascular risk marker in several clinical settings (Ben-Shlomo et al, 2014), including in RHT (Cardoso, Salles, & Salles, 2019). Otherwise, although some previous non-randomized observational studies suggested that CPAP treatment might reduce aortic stiffness (Buchner et al, 2012;Kartali et al, 2014;Mineiro et al, 2017), few randomized controlled trials (RCTs) evaluated this hypothesis, with controversial findings (Drager, Bortolotto, Figueiredo, Krieger, & Lorenzi, 2007;Jain et al, 2017;Jones et al, 2013;Litvin et al, 2013;Ning et al, 2019;Paz y Mar et al, 2016), and none of them were in RHT patients.…”