The Impact of CPAP on Cardiovascular Biomarkers in Minimally Symptomatic Patients with Obstructive Sleep Apnea: A Pilot Feasibility Randomized Crossover Trial

Comondore, Vikram R.; Cheema, Rupi; Fox, Jessica K.; Butt, Abdalla; Mancini, G.B. John; Fleetham, John A.; Ryan, C. Frank; Chan, Sammy; Ayas, Najib

doi:10.1007/s00408-008-9115-5

Cited by 91 publications

(89 citation statements)

References 26 publications

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“…A total of five studies (26,27,(30)(31)(32) that enrolled 244 subjects (83% male) met the inclusion criteria. Figure 1 describes our search for these studies.…”

Section: Resultsmentioning

confidence: 99%

Meta-analysis: Continuous Positive Airway Pressure Improves Insulin Resistance in Patients with Sleep Apnea without Diabetes

et al. 2013

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Rationale: Obstructive sleep apnea (OSA) is an independent risk factor for the development of insulin resistance (IR). Treatment with continuous positive airway pressure (CPAP) for OSA has shown conflicting results on IR.Objectives: To conduct a meta-analysis of randomized controlled trials (RCTs) that have evaluated the effect of CPAP on a validated index of IR, the homeostasis model assessment of insulin resistance (HOMA-IR).Methods: PubMed and Embase were searched through August 10, 2012. Two independent reviewers screened citations to identify trials of the effect of CPAP on HOMA-IR. Data were extracted for postintervention HOMA-IR values. Measurements and Main Results:A total of five studies that enrolled 244 subjects (83% male) met the inclusion criteria. None of the subjects in the included studies had diabetes. The pooled estimate of the difference in means in HOMA-IR between the CPAP and sham CPAP/control groups was 20.44 (95% confidence interval, 20.82 to 20.06; P = 0.02). The funnel plot does not suggest the presence of any publication bias. The I-squared index for the data on difference in means in HOMA-IR between the CPAP and sham CPAP/control groups was 0.00 (P = 0.61). Conclusions:The pooled estimate of RCTs shows a favorable effect of CPAP on insulin resistance as measured by HOMA-IR in patients with OSA without diabetes. The effect size on HOMA-IR is modest, but not insignificant, when compared with the effects of thiazolidinedione in nondiabetic patients with metabolic syndrome. Further research and RCTs are warranted involving a larger number of patients and longer treatment periods to determine the beneficial effects of CPAP on IR.

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“…A total of five studies (26,27,(30)(31)(32) that enrolled 244 subjects (83% male) met the inclusion criteria. Figure 1 describes our search for these studies.…”

Section: Resultsmentioning

confidence: 99%

Meta-analysis: Continuous Positive Airway Pressure Improves Insulin Resistance in Patients with Sleep Apnea without Diabetes

et al. 2013

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“…In a recent randomized controlled trial, 24 weeks of CPAP treatment alone (on average z4 h per night) did not improve insulin sensitivity as assessed by ivGTT (27). Previous randomized controlled trials have found no benefit of CPAP treatment on measures of glucose metabolism when the duration of average CPAP use ranged from 3.3 to 6.2 hours per night (20)(21)(22)(23)(24)(25)(26)(27)(28). In one controlled study involving individuals with prediabetes, 2 months of CPAP use (on average z4.8 h per night) led to an improvement in insulin sensitivity only in those who had severe OSA (29).…”

Section: Discussionmentioning

confidence: 96%

“…Despite this strong association between OSA and alterations in glucose metabolism, there is still controversy as to whether treatment of OSA with continuous positive airway pressure (CPAP) has metabolic benefits (18,19). Prior randomized controlled trials investigating the effects of CPAP on measures of glucose metabolism yielded mostly negative results (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30). The average duration of CPAP use in these trials ranged from 3.3 to 6.2 hours per night.…”

mentioning

confidence: 99%

Eight Hours of Nightly Continuous Positive Airway Pressure Treatment of Obstructive Sleep Apnea Improves Glucose Metabolism in Patients with Prediabetes. A Randomized Controlled Trial

Pamidi

Wroblewski²,

Stępień

et al. 2015

Am J Respir Crit Care Med

153

117

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Rationale: Although obstructive sleep apnea (OSA) is associated with impaired glucose tolerance and diabetes, it remains unclear whether OSA treatment with continuous positive airway pressure (CPAP) has metabolic benefits.Objectives: To determine the effect of 8-hour nightly CPAP treatment on glucose metabolism in individuals with prediabetes and OSA.Methods: In a randomized controlled parallel group study, 39 participants were randomly assigned to receive either 8-hour nightly CPAP (n = 26) or oral placebo (n = 13). Sleep was polysomnographically recorded in the laboratory on each night. CPAP adherence was ensured by continuous supervision. Participants continued their daily routine activities outside the laboratory. Glucose metabolism was assessed at baseline and after 2 weeks of assigned treatment using both the oral and intravenous glucose tolerance tests. The primary outcome was the overall glucose response as quantified by the area under the curve for glucose during 2-hour oral glucose tolerance testing. Secondary outcomes included fasting and 2-hour glucose and insulin, the area under the curves for insulin and insulin secretion, norepinephrine, insulin sensitivity, acute insulin response to glucose, and 24-hour blood pressure.

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“…It is not clear if asymptomatic or minimally symptomatic patients with mild or moderate OSAHS have the same cardiovascular risk with those with symptoms. If they do not, then the detection of only the clinically symptomatic patients with the help of questionnaires may be adequate (13). Additionally patients with excessive sleepiness are more likely to respond to treatment (14).…”

Section: Discussionmentioning

confidence: 99%

During economic crisis can sleep questionnaires improve the value of oximetry for assessing sleep apnea?

et al. 2016

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Background: The diagnosis of obstructive sleep apnea/hypopnea syndrome (OSAHS) is essential but polysomnography (PSG) is expensive and time consuming. Oximetry has been used as a less expensive indicator of OSAHS. The aim of the study was to evaluate the clinical utility of the combination of oximetry with four different questionnaires: Stop, Stop Bang (S-B), Berlin questionnaire (BQ), Epworth Sleepiness Scale (ESS) in order to identify patients at risk for OSAHS compared with in-laboratory PSG.Methods: Patients visiting a sleep clinic were prospectively studied. They completed Stop, S-B, BQ and ESS.Home oximetry and in laboratory PSG were performed within 3-20 days.Results: A total of 204 patients were included in the study (77.5% males, mean age 51.8±13.8 years, BMI 32.8±6.2 kg/m 2 , SaO 2 % awake 95.7±2). S-B had the highest sensitivity (Se) (97.5%) and negative predictive value (NPV) (62.5%) but the lowest specificity (Sp) (9%), whereas ESS had the best Sp (75%) and positive predictive values (PPV) (81.4%). The predictive values of questionnaires improved as the severity of OSAHS worsened. The predictive values of oximetry were high for severe but low for mild and moderate OSAHS. For that oximetry was combined with different sleep questionnaires in different OSAHS severity groups, but with no improvement in the predictive values.Conclusions: Oximetry may be used as a tool for identifying severe OSAHS. For mild and moderate disease the combination of questionnaires did not improve the diagnostic accuracy and especially for symptomatic patients with negative results, the need of PSG is essential.

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The Impact of CPAP on Cardiovascular Biomarkers in Minimally Symptomatic Patients with Obstructive Sleep Apnea: A Pilot Feasibility Randomized Crossover Trial

Abstract: In this pilot study there were potential improvements in a variety of cardiovascular biomarkers with CPAP. CPAP compliance was reasonably good even though patients were not particularly sleepy. Accordingly, larger randomized controlled trials in this area appear feasible and warranted.

Cited by 91 publications

References 26 publications

Meta-analysis: Continuous Positive Airway Pressure Improves Insulin Resistance in Patients with Sleep Apnea without Diabetes

Meta-analysis: Continuous Positive Airway Pressure Improves Insulin Resistance in Patients with Sleep Apnea without Diabetes

Eight Hours of Nightly Continuous Positive Airway Pressure Treatment of Obstructive Sleep Apnea Improves Glucose Metabolism in Patients with Prediabetes. A Randomized Controlled Trial

During economic crisis can sleep questionnaires improve the value of oximetry for assessing sleep apnea?

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