1
|
Ando SI. Can we obtain a reliable marker that shows the hypoxic burden in patients with sleep disordered breathing? Hypertens Res 2023; 46:2500-2502. [PMID: 37673960 DOI: 10.1038/s41440-023-01425-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 08/02/2023] [Accepted: 08/10/2023] [Indexed: 09/08/2023]
Affiliation(s)
- Shin-Ichi Ando
- Sleep medicine center, Cardiovascular division, Fukuokaken Saiseikai Futsukaichi Hospital, 3-13-1 Yumachi, Chikushino, Fukuoka, 818-8582, Japan.
| |
Collapse
|
2
|
Shang W, Zhang Y, Wang G, Han D. Benefits of continuous positive airway pressure on glycaemic control and insulin resistance in patients with type 2 diabetes and obstructive sleep apnoea: A meta-analysis. Diabetes Obes Metab 2021; 23:540-548. [PMID: 33146450 DOI: 10.1111/dom.14247] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 10/16/2020] [Accepted: 11/01/2020] [Indexed: 01/09/2023]
Abstract
AIM To conduct a meta-analysis to determine the effects of continuous positive airway pressure (CPAP) treatment on glycaemic control and insulin resistance in patients with type 2 diabetes and obstructive sleep apnoea (OSA). METHODS A systematic search was made of the MEDLINE, SCOPUS, ISI Web of Science, Cochrane databases, and clinicaltrials.gov, without language restrictions. Randomized controlled trials on treatment of type 2 diabetes and OSA with CPAP, compared with sham CPAP or no CPAP, were reviewed. Studies were pooled to obtain standardized mean differences (SMDs), with 95% confidence intervals (CIs). RESULTS Seven trials (enrolling 691 participants) met the inclusion criteria. CPAP showed significant effects on glycated haemoglobin (HbA1c; SMD -0.32, 95% CI -0.60 to -0.03; P = 0.029), fasting glucose (SMD -0.39, 95% CI -0.76 to -0.02; P = 0.040), homeostatic model assessment of insulin resistance (HOMA-IR; SMD -1.05, 95% CI -1.91 to -0.19; P = 0.016), systolic blood pressure (SMD -1.18, 95% CI -2.29 to -0.07 mm Hg; P = 0.037), and diastolic blood pressure (SMD -1.29, 95% CI -2.48 to -0.09; P = 0.035). CONCLUSIONS Continuous positive airway pressure treatment significantly improved glycaemic control and insulin resistance, as shown by the decreased HbA1c levels, fasting glucose levels and HOMA-IR values in patients with type 2 diabetes and OSA.
Collapse
Affiliation(s)
- Wenli Shang
- Department of Respiratory and Critical Care Medicine, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Yingying Zhang
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an, China
| | - Guizuo Wang
- Department of Respiratory and Critical Care Medicine, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Dong Han
- Department of Respiratory and Critical Care Medicine, Shaanxi Provincial People's Hospital, Xi'an, China
| |
Collapse
|
3
|
SÖkÜcÜ SN, Özdemİr C, Aydin Ş, ÖnÜr ST, Kahya Ö. Uric acid as a marker of severity of obstructive sleep apnoea syndrome in older patients. ARQUIVOS DE NEURO-PSIQUIATRIA 2020; 78:783-788. [PMID: 33331514 DOI: 10.1590/0004-282x20200069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 05/18/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Uric acid has been shown to be related to the severity of obstructive sleep apnoea syndrome (OSAS) in adults. We assessed the role of uric acid in OSAS in a cohort of older patients. METHODS A total of 164 patients aged >65 years, admitted to our sleep laboratory between January 1st, 2016 and July 1st, 2018 with a complaint of snoring, underwent overnight polysomnography and were retrospectively evaluated. RESULTS A total of 126 patients who fulfilled the inclusion criteria (mean age 69.16±3.68 years, 56% men) were included. The control group was comprised of 14 patients, while the OSAS group consisted of 112 patients (31 mild, 44 moderate and 37 severe cases). No differences were observed in age, sex, hip circumference, waist/hip ratio or comorbidities between the groups. The Epworth Sleepiness Scale score, body mass index (BMI), and waist circumference were significantly higher in OSAS patients than in controls (p=0.001, p=0.02, and p=0.36, respectively). Uric acid was not correlated with any of the sleep parameters, and no significant differences were detected between the groups. Hyperuricemic patients were similar in terms of sleep parameters and comorbidities in comparison with the other patients. CONCLUSIONS No relationship was observed between uric acid level and OSAS severity, as defined by the apnoea-hypopnea index. Further studies are needed to determine the value of uric acid as a marker of OSAS, after controlling for cardiovascular comorbidities, in older patients with this syndrome.
Collapse
Affiliation(s)
- Sinem Nedime SÖkÜcÜ
- Yedikule Chest Disease and Thoracic Surgery Training and Research Hospital, Pulmonology Istanbul, Turkey
| | - Cengiz Özdemİr
- Yedikule Chest Disease and Thoracic Surgery Training and Research Hospital, Pulmonology Istanbul, Turkey
| | - Şenay Aydin
- Yedikule Chest Disease and Thoracic Surgery Training and Research Hospital, Neurology Istanbul, Turkey
| | - Seda Tural ÖnÜr
- Yedikule Chest Disease and Thoracic Surgery Training and Research Hospital, Pulmonology Istanbul, Turkey
| | - Özlem Kahya
- Yedikule Chest Disease and Thoracic Surgery Training and Research Hospital, Pulmonology Istanbul, Turkey
| |
Collapse
|
4
|
Lai CH, Huang RJ, Wong JKS, Chang SW, Chung AH, Chi YC, Yu YC, Lee SD, Ting H. Confounded by obesity and modulated by urinary uric acid excretion, sleep-disordered breathing indirectly relates to hyperuricaemia in males: A structural equation model. J Sleep Res 2020; 30:e13108. [PMID: 32767532 DOI: 10.1111/jsr.13108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 05/01/2020] [Accepted: 05/15/2020] [Indexed: 11/26/2022]
Abstract
Sleep-disordered breathing (SDB) causes hypoxic stress and can trigger uric acid (UA) overproduction. We comprehensively investigated whether SDB, interacting with components of metabolic syndrome, hepatic and renal dysfunctions, low physical fitness, sedentary lifestyle, disrupted sleep, and chronic systemic inflammation (CSI), is directly associated with hyperuricaemia. In 528 community-based males (mean [SD] age 46.2 [7.4] years), we cross-sectionally analysed measures of anthropometry; self-reported lifestyle habits; overnight sleep polysomnography data; cardiopulmonary exercise tests; and biomarkers of cardiometabolic, hepatic, and renal functions; and CSI, using structural equation modelling. Objective disrupted sleep, C-reactive protein, low physical fitness, and sedentary lifestyle were not related to UA levels in univariate analysis and were excluded. The latent variables (with corresponding manifest variables) obesity (body mass index, waist-hip ratio), hypertension (post-sleep systolic, diastolic blood pressure), dyslipidaemia (total cholesterol, triglyceride/high-density lipoprotein cholesterol), hepatic dysfunction (alanine aminotransferase, aspartate transaminase), and renal dysfunction (blood urea nitrogen, serum creatinine) were positively; and hyperglycaemia (fasting glucose, glycated haemoglobin) was negatively associated with hyperuricaemia (serum UA), except for SDB (Apnea-Hypopnea Index, percentage of oxygen saturation <90% period against total sleep time, oxygen desaturation index) in the one-stage influence model. In the two-stage model, SDB, closely interacting with obesity, was positively indirectly associated with hyperuricaemia through directly linked renal dysfunction and obesity-linked hypertension, inverse hyperglycaemia, dyslipidaemia, and hepatic dysfunction. In conclusion, structural equation modelling reveals that SDB closely interacts with obesity and is positively but indirectly related to hyperuricaemia in males. This suggests that urinary UA excretion modulates and obesity confounds the SDB-hyperuricaemia relationship.
Collapse
Affiliation(s)
- Ching-Hsiang Lai
- Department of Medical Informatics, Chung Shan Medical University, Taichung, Taiwan
| | - Ren-Jing Huang
- Department of Medical Image and Radiological Sciences, Chung Shan Medical University, Taichung, Taiwan
| | | | - Shen-Wen Chang
- Sleep Medicine Center, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Ai-Hui Chung
- Sleep Medicine Center, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Yung-Chun Chi
- Department of Physical Medicine and Rehabilitation, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Yi-Chen Yu
- Department of Physical Medicine and Rehabilitation, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Shin-Da Lee
- Department of Physical Therapy, Graduate Institute of Rehabilitation Science, China Medical University, Taichung, Taiwan.,Department of Occupational Therapy, Asia University, Taichung, Taiwan.,School of Rehabilitation Science, Affiliated Seventh People Hospital, Shanghai University of TCM, Shanghai, China
| | - Hua Ting
- Sleep Medicine Center, Chung Shan Medical University Hospital, Taichung, Taiwan.,Department of Physical Medicine and Rehabilitation, Chung Shan Medical University Hospital, Taichung, Taiwan.,Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
| |
Collapse
|
5
|
Loffler KA, Heeley E, Freed R, Meng R, Bittencourt LR, Gonzaga Carvalho CC, Chen R, Hlavac M, Liu Z, Lorenzi-Filho G, Luo Y, McArdle N, Mukherjee S, Yap HS, Zhang X, Palmer LJ, Anderson CS, McEvoy RD, Drager LF. Continuous Positive Airway Pressure Treatment, Glycemia, and Diabetes Risk in Obstructive Sleep Apnea and Comorbid Cardiovascular Disease. Diabetes Care 2020; 43:1859-1867. [PMID: 32291275 DOI: 10.2337/dc19-2006] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 03/15/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Despite evidence of a relationship among obstructive sleep apnea (OSA), metabolic dysregulation, and diabetes, it is uncertain whether OSA treatment can improve metabolic parameters. We sought to determine effects of long-term continuous positive airway pressure (CPAP) treatment on glycemic control and diabetes risk in patients with cardiovascular disease (CVD) and OSA. RESEARCH DESIGN AND METHODS Blood, medical history, and personal data were collected in a substudy of 888 participants in the Sleep Apnea cardioVascular Endpoints (SAVE) trial in which patients with OSA and stable CVD were randomized to receive CPAP plus usual care, or usual care alone. Serum glucose and glycated hemoglobin A1c (HbA1c) were measured at baseline, 6 months, and 2 and 4 years and incident diabetes diagnoses recorded. RESULTS Median follow-up was 4.3 years. In those with preexisting diabetes (n = 274), there was no significant difference between the CPAP and usual care groups in serum glucose, HbA1c, or antidiabetic medications during follow-up. There were also no significant between-group differences in participants with prediabetes (n = 452) or new diagnoses of diabetes. Interaction testing suggested that women with diabetes did poorly in the usual care group, while their counterparts on CPAP therapy remained stable. CONCLUSIONS Among patients with established CVD and OSA, we found no evidence that CPAP therapy over several years affects glycemic control in those with diabetes or prediabetes or diabetes risk over standard-of-care treatment. The potential differential effect according to sex deserves further investigation.
Collapse
Affiliation(s)
- Kelly A Loffler
- Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Emma Heeley
- Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.,The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Ruth Freed
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Rosie Meng
- Flinders Centre for Epidemiology and Biostatistics, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Lia R Bittencourt
- Instituto do Sono, Associação Fundo de Incentivo a Pesquisa, São Paulo, Brazil
| | | | - Rui Chen
- The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | | | | | - Geraldo Lorenzi-Filho
- Sleep Laboratory, Pulmonary Division, Instituto do Coração, University of São Paulo, São Paulo, Brazil
| | - Yuanming Luo
- The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, Guangzhou, Guangdong, China
| | - Nigel McArdle
- West Australian Sleep Disorders Research Institute, Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Sutapa Mukherjee
- Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.,West Australian Sleep Disorders Research Institute, Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.,Sleep Health Service, Respiratory and Sleep Services, Southern Adelaide Local Health Network, Bedford Park, South Australia, Australia
| | - Hooi Shan Yap
- Sleep Health Service, Respiratory and Sleep Services, Southern Adelaide Local Health Network, Bedford Park, South Australia, Australia
| | - Xilong Zhang
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Lyle J Palmer
- School of Public Health, University of Adelaide, Adelaide, South Australia, Australia
| | - Craig S Anderson
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia.,The George Institute for Global Health China at Peking University Health Science Center, Beijing, China
| | - R Doug McEvoy
- Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia .,Sleep Health Service, Respiratory and Sleep Services, Southern Adelaide Local Health Network, Bedford Park, South Australia, Australia
| | | | | |
Collapse
|
6
|
Liu PY. A Clinical Perspective of Sleep and Andrological Health: Assessment, Treatment Considerations, and Future Research. J Clin Endocrinol Metab 2019; 104:4398-4417. [PMID: 31042277 PMCID: PMC6735730 DOI: 10.1210/jc.2019-00683] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 04/25/2019] [Indexed: 12/29/2022]
Abstract
CONTEXT Sleep that is insufficient, misaligned, or disrupted causes hypersomnolence and neuropsychological deficits, adversely affects cardiometabolic health, and is increasingly recognized to impair other biological processes that lead to conditions important to men, such as hypogonadism, erectile dysfunction, and infertility. EVIDENCE ACQUISITION Literature review from 1970 to December 2018. EVIDENCE SYNTHESIS High-quality and complementary epidemiological and interventional studies establish that abnormal sleep is associated with increased mortality, hypertension, and other cardiometabolic disorders (insufficient, disrupted, and misaligned sleep), as well as reduced fecundity and total sperm count (insufficient sleep), erectile dysfunction (disrupted sleep), and low testosterone (both). Circadian misalignment shifts the peak of testosterone's diurnal rhythm to occur soon after waking up, irrespective of the biological clock time, but it does not change the mean concentration. Preliminary studies show that extending sleep in individuals who are chronically sleep deprived may become a strategy to reduce insulin resistance and hypertension. Continuous positive airway pressure therapy can improve erectile function, and possibly systemic testosterone exposure, but only when used adherently by men with obstructive sleep apnea. Both high-dose and replacement-dose testosterone therapies modestly worsen sleep-disordered breathing, but they also improve cardiometabolic function and sexual desire. Persistence of either the adverse or beneficial outcomes over the longer term requires further investigation. CONCLUSIONS Sleep is increasingly recognized to be essential for healthy living. Establishing the effect of abnormal sleep, and of improving sleep, on andrological issues of prime interest to men will promote prioritization of sleep, and may thereby improve overall long-term health outcomes.
Collapse
Affiliation(s)
- Peter Y Liu
- Division of Endocrinology, Metabolism, and Nutrition, Department of Medicine, Harbor-UCLA Medical Center and Los Angeles Biomedical Research Institute, Torrance, California
- David Geffen School of Medicine at UCLA, Los Angeles, California
- Correspondence and Reprint Requests: Peter Y. Liu, PhD, Division of Endocrinology and Metabolism, Department of Medicine, Harbor UCLA Medical Center and Los Angeles Biomedical Research Institute, 1124 West Carson Street, Box 446, Torrance, California 90502. E-mail:
| |
Collapse
|
7
|
Does Continuous Positive Airway Pressure Therapy in Patients with Obstructive Sleep Apnea Improves Uric Acid? A Meta-Analysis. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2019; 2019:4584936. [PMID: 31636804 PMCID: PMC6766132 DOI: 10.1155/2019/4584936] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Revised: 07/25/2019] [Accepted: 08/26/2019] [Indexed: 11/18/2022]
Abstract
Purpose The efficacy of obstructive sleep apnea (OSA) therapy with continuous positive airway pressure (CPAP) on uric acid (UA) yielded conflicting results. This meta-analysis was performed to assess whether OSA treatment with CPAP could reduce UA levels. Methods The Web of Science, Cochrane Library, Embase, and PubMed were searched before March 2019. Information of patients, study design, and pre- and post-CPAP treatment of UA was utilized for analysis. The overall effects were analyzed via the standardized mean difference (SMD) with a 95% confidence interval (CI). Five studies were obtained and the meta-analysis was performed using Stata 12.0 and Review Manager 5.2. Results A total of 5 studies with 6 cohorts (2 RCT and 3 observational studies) involving 270 patients were pooled into meta-analysis. There was no change of UA levels before and after CPAP treatment in OSA patients (SMD = ‐0.20, 95% CI: -0.78 to 0.37, Z = 0.69, p = 0.49). Subgroup analysis showed that the outcomes were not affected by age of patients, gender distribution, baseline body mass index, daily duration, duration of CPAP treatment, sample size, and study design. Conclusions This meta-analysis revealed that CPAP treatment has no effect on UA in OSA patients. Further well-designed, large-scale randomized controlled trials are required to address this issue.
Collapse
|
8
|
Blagojevic-Bucknall M, Mallen C, Muller S, Hayward R, West S, Choi H, Roddy E. The Risk of Gout Among Patients With Sleep Apnea: A Matched Cohort Study. Arthritis Rheumatol 2018; 71:154-160. [PMID: 30160059 DOI: 10.1002/art.40662] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 07/05/2018] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Obstructive sleep apnea (OSA) is associated with a range of serious comorbidities. This study was undertaken to investigate whether people with OSA are more likely to develop gout, in the short and long term, compared to those without OSA. METHODS A matched retrospective cohort study was undertaken using the UK Clinical Practice Research Datalink. Individuals age ≥18 years who received a diagnosis of OSA between 1990 and 2010 were identified and matched on age, sex, and practice with up to 4 individuals without OSA; follow-up was until the end of 2015. Hazard ratios (HRs) were estimated using Cox regression adjusted for general health, lifestyle, and comorbidity characteristics. The risk of developing gout was assessed at different time points, and the body mass index (BMI) category-specific results were presented. RESULTS The study sample included 15,879 patients with OSA and 63,296 without. The median follow-up was 5.8 years. We found that 4.9% of patients with OSA and 2.6% of patients without the disorder developed gout. The incidence rate per 1,000 person-years was 7.83 (95% confidence interval [95% CI] 7.29-8.40) and 4.03 (95% CI 3.84-4.23) among those with and without OSA, respectively. The adjusted HR was 1.42 (95% CI 1.29-1.56). The risk of developing gout among OSA patients compared to those without was highest 1-2 years after the index date (HR 1.64 [95% CI 1.30-2.06]). This finding persisted among those who were overweight and obese. For those with normal BMI, the highest significant HR (2.02 [95% CI 1.13-3.62]) was observed at 2-5 years after the index date. CONCLUSION In this study, patients with OSA continued to be at higher risk of developing gout beyond the first year following the diagnosis. Our results further indicate that peak incidences of gout vary according to BMI.
Collapse
Affiliation(s)
- Milica Blagojevic-Bucknall
- Keele University, Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Services, Newcastle-under-Lyme, Staffordshire, UK
| | - Christian Mallen
- Keele University, Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Services, Newcastle-under-Lyme, Staffordshire, UK
| | - Sara Muller
- Keele University, Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Services, Newcastle-under-Lyme, Staffordshire, UK
| | - Richard Hayward
- Keele University, Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Services, Newcastle-under-Lyme, Staffordshire, UK
| | - Sophie West
- Newcastle University, Freeman Hospital, Newcastle upon Tyne, UK
| | - Hyon Choi
- Massachusetts General Hospital, Boston
| | - Edward Roddy
- Keele University, Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Services, Newcastle-under-Lyme, Staffordshire, UK
| |
Collapse
|
9
|
Continuous Positive Airway Pressure Treatment Does not Reduce Uric Acid Levels in OSA Women. Arch Bronconeumol 2018; 55:201-207. [PMID: 30446250 DOI: 10.1016/j.arbres.2018.09.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 09/12/2018] [Accepted: 09/14/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Although an association between uric acid (UA) levels and obstructive sleep apnea (OSA) has been reported, the effect of continuous positive airway pressure (CPAP) on this measure is yet unclear. We aimed to investigate the effect of CPAP therapy on serum UA levels in patients with OSA. METHODS We conducted a multicenter, open-label, randomized controlled trial in 307 women diagnosed with moderate-to-severe OSA (apnea-hypopnea index [AHI]≥15) in 19 Spanish Sleep Units. Women were randomized to CPAP (n=151) or conservative treatment (n=156) for 12 weeks. Changes in serum UA measures were assessed on an intention-to-treat basis. Additional analyses were conducted in the subgroup of women with CPAP adherence ≥4h/night and those with UA levels ≥6mg/dl. RESULTS Women had a mean (SD) age of 57.1 (10.1) years, median (first-third quartile) body mass index of 33.7 (29.0-38.5) mg/kg2 and AHI of 32.0 (22.6-48.5). The average serum UA measure was 5.11 (1.26) mg/dl, and 80 (26.1%) participants had UA≥6mg/dl. Compared with the control group, the CPAP group did not achieve any reduction in UA levels (non-adjusted intergroup difference -0.03mg/dl, 95%CI -0.20 to 0.13; p=0.702) after 12 weeks of follow-up. These results did not change when the analysis was restricted to women with CPAP adherence ≥4h/night, or the subgroup of women with hyperuricemia. CONCLUSIONS Twelve weeks of CPAP therapy does not reduce UA levels compared to conservative treatment in women with moderate-to-severe OSA.
Collapse
|
10
|
Labarca G, Reyes T, Jorquera J, Dreyse J, Drake L. CPAP in patients with obstructive sleep apnea and type 2 diabetes mellitus: Systematic review and meta-analysis. THE CLINICAL RESPIRATORY JOURNAL 2018; 12:2361-2368. [PMID: 30073792 DOI: 10.1111/crj.12915] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Revised: 04/15/2018] [Accepted: 05/13/2018] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Obstructive sleep apnea hypopnea syndrome (OSAHS) is a prevalent condition across the world; it co-exists with others metabolic diseases, such as central obesity, dyslipidemia, and arterial hypertension. These associations increase the cardiovascular risk and mortality. Observational studies have reported a strength association between OSA and type 2 Diabetes Mellitus (T2DM) and continuous positive airway pressure (CPAP) is recommended for moderate to severe OSAHS. OBJECTIVE To summarize the evidence of CPAP in T2DM patients with OSAHS. METHODS A compressive search in Medline, Cochrane, Ovids, Epistemonikos, and DARE was performed. Two reviewers evaluated included studies, extracted data, carried out quality assessment and summarized the result. Pooled data was evaluated by meta-analysis and summaries of results and evidence grading were performed through the GRADE method. RESULTS Six randomized controlled trials (RCTs), including a total of 581 participants. Treatment with CPAP showed no effectiveness regarding changing glycated hemoglobin (HbA1c) levels at 12 or 24 weeks after treatment; (Mean difference= -0.10; Confidence interval -0.25 to 0.04) (GRADE: MODERATE). Subgroup analysis by adherence to CPAP (> 4 hours or < 4 hours) confirmed these results. Other indirect outcomes, such as change in fasting glucose levels, were similar in CPAP population and placebo. DISCUSSION This systematic review and meta-analysis evaluates the evidence regarding the efficacy of CPAP in patients with T2DM and OSAHS. In conclusion, CPAP does not improve glycemic control measure as HbA1c.
Collapse
Affiliation(s)
- Gonzalo Labarca
- Facultad de Medicina, Universidad San Sebastian, Concepcion, Chile
- Medicina Interna, Complejo Asistencial Dr. Victor Rios Ruiz, Los Angeles, Chile
- Evidence Based Medicine in Pulmonology (EBMIP) Working Group, Concepcion, Chile
| | - Tomas Reyes
- Medicina Interna, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Jorge Jorquera
- Evidence Based Medicine in Pulmonology (EBMIP) Working Group, Concepcion, Chile
- Centro de Enfermedades respiratorias, Clinca Las Condes, Santiago, Chile
| | - Jorge Dreyse
- Evidence Based Medicine in Pulmonology (EBMIP) Working Group, Concepcion, Chile
- Centro de Enfermedades respiratorias, Clinca Las Condes, Santiago, Chile
| | - Lauren Drake
- Medical Student, A.T. Still University Kirksville College of Osteopathic Medicine, Kirksville, MO
| |
Collapse
|
11
|
Seetho IW, Parker RJ, Craig S, Duffy N, Hardy KJ, Wilding JPH, Goodson NJ. Serum urate and obstructive sleep apnoea in severe obesity. Chron Respir Dis 2015; 12:238-46. [DOI: 10.1177/1479972315586197] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Obstructive sleep apnoea (OSA) may increase the risk of hyperuricaemia and predispose to gout. The evidence for the effects of OSA on serum urate in severe obesity is limited. This study investigated whether OSA was associated with serum urate in severe obesity and whether continuous positive airway pressure (CPAP) treatment was associated with a fall in urate. Severely obese subjects without known OSA or gout were recruited. Baseline assessments included urate, metabolic parameters, spirometry and overnight polysomnography. OSA patients were initially naive to treatment and were offered CPAP. At follow-up, change in urate was compared between CPAP-treated and non-CPAP-treated subjects. A high urate was defined as greater than the median. Logistic regression was performed to identify associations between (1) OSA and high urate at baseline and (2) use of CPAP and change in urate at follow-up. In total, 92 subjects were recruited (61 (66%) OSA and 31 (34%) non-OSA). Median urate was 345 μmol/L. OSA was associated with high urate in females at baseline after adjusting for confounders (adjusted odds ratio ORadj = 10.2; 95% CI: 1.1, 93.5). At follow-up (14 months), 58 subjects (28 on CPAP and 30 not on CPAP) were reassessed. CPAP was significantly associated with a fall to a low urate category at follow-up ( = 0.017). Regression revealed a trend for a fall in urate category in the CPAP-treated group (ORadj = 9.3; 95% CI: 0.8, 97). Serum urate is associated with OSA in severely obese females and CPAP may reduce levels in patients with OSA. There may be a need to consider and assess for OSA in obese patients with hyperuricaemia and recurrent attacks of gout.
Collapse
Affiliation(s)
- Ian W Seetho
- Department of Obesity and Endocrinology, University of Liverpool, Clinical Sciences Centre, University Hospital Aintree, Liverpool, UK
| | - Robert J Parker
- Department of Respiratory Medicine, University Hospital Aintree, Liverpool, UK
| | - Sonya Craig
- Department of Respiratory Medicine, University Hospital Aintree, Liverpool, UK
| | - Nick Duffy
- Department of Respiratory Medicine, University Hospital Aintree, Liverpool, UK
| | - Kevin J Hardy
- Department of Diabetes and Endocrinology, St Helens and Knowsley Teaching Hospitals NHS Trust, Prescot, UK
| | - John PH Wilding
- Department of Obesity and Endocrinology, University of Liverpool, Clinical Sciences Centre, University Hospital Aintree, Liverpool, UK
| | - Nicola J Goodson
- Department of Academic Rheumatology, Institute of Chronic Disease and Ageing, University of Liverpool, University Hospital Aintree, Liverpool, UK
| |
Collapse
|
12
|
Marvisi M, Vento MG, Balzarini L, Mancini C, Marvisi C. Continuous Positive Airways Pressure and Uvulopalatopharyngoplasty Improves Pulmonary Hypertension in Patients with Obstructive Sleep Apnoea. Lung 2015; 193:269-74. [DOI: 10.1007/s00408-015-9694-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 02/03/2015] [Indexed: 02/02/2023]
|
13
|
Abstract
Patients with obesity and obstructive sleep apnoea have increased morbidity. Now, one study has reported limited beneficial effects of continuous positive airway pressure (CPAP) in patients with both these conditions. However, in another study, the reduction in blood pressure obtained with CPAP was not observed when nocturnal hypoxia was suppressed with supplemental oxygen.
Collapse
Affiliation(s)
- Patrick Lévy
- University of Grenoble Alpes, Department of Physiology, Sleep Laboratory, Grenoble University Hospital, Grenoble 38043, France
| | - Jean-Louis Pépin
- University of Grenoble Alpes, Department of Physiology, Sleep Laboratory, Grenoble University Hospital, Grenoble 38043, France
| |
Collapse
|
14
|
Jullian-Desayes I, Joyeux-Faure M, Tamisier R, Launois S, Borel AL, Levy P, Pepin JL. Impact of obstructive sleep apnea treatment by continuous positive airway pressure on cardiometabolic biomarkers: a systematic review from sham CPAP randomized controlled trials. Sleep Med Rev 2014; 21:23-38. [PMID: 25220580 DOI: 10.1016/j.smrv.2014.07.004] [Citation(s) in RCA: 132] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Revised: 07/09/2014] [Accepted: 07/12/2014] [Indexed: 12/24/2022]
Abstract
Reducing cardiometabolic risk may represent an important target for effective obstructive sleep apnea (OSA) treatment. The impact of continuous positive airway pressure (CPAP), the first line therapy of OSA, on metabolic or inflammatory markers is still debated. A systematic literature search using several databases was performed. We provide a systematic analysis of randomized studies comparing therapeutic versus sham CPAP intervention and also include studies using a CPAP withdrawal design. We addressed the impact of CPAP on the following cardiometabolic biomarkers: 1) plasma and urine catecholamines and their metabolites that reflect sympathetic activity; 2) insulin resistance and lipid metabolism biomarkers; 3) oxidative stress, systemic and vascular inflammation biomarkers; 4) liver enzymes highlighting the association between OSA and nonalcoholic fatty liver disease (NAFLD); 5) coagulation biomarkers. The impact of CPAP on sympathetic activity is robust across studies and occurs rapidly. In contrast to sympathetic activity, the well-designed studies included in this review failed to demonstrate that CPAP alters metabolic or inflammatory markers in OSA. CPAP did not change glucose, lipids, insulin resistance levels or the ratio of patients with metabolic syndrome. In unselected OSA patients, it is not realistic to expect a clinically relevant decrease in cardiometabolic biomarkers with CPAP therapy.
Collapse
Affiliation(s)
- Ingrid Jullian-Desayes
- Université Grenoble Alpes, HP2, Inserm U1042, Grenoble, France; CHU de Grenoble, Laboratoire EFCR, Secteur Physiologie Sommeil et Exercice, Pole Thorax et Vaisseaux Grenoble, France
| | - Marie Joyeux-Faure
- Université Grenoble Alpes, HP2, Inserm U1042, Grenoble, France; CHU de Grenoble, Laboratoire EFCR, Secteur Physiologie Sommeil et Exercice, Pole Thorax et Vaisseaux Grenoble, France
| | - Renaud Tamisier
- Université Grenoble Alpes, HP2, Inserm U1042, Grenoble, France; CHU de Grenoble, Laboratoire EFCR, Secteur Physiologie Sommeil et Exercice, Pole Thorax et Vaisseaux Grenoble, France
| | - Sandrine Launois
- Université Grenoble Alpes, HP2, Inserm U1042, Grenoble, France; CHU de Grenoble, Laboratoire EFCR, Secteur Physiologie Sommeil et Exercice, Pole Thorax et Vaisseaux Grenoble, France
| | - Anne-Laure Borel
- Université Grenoble Alpes, HP2, Inserm U1042, Grenoble, France; CHU de Grenoble, Département d'Endocrinologie Diabétologie - Maladies de la Nutrition, Pôle Digidune, Grenoble, France
| | - Patrick Levy
- Université Grenoble Alpes, HP2, Inserm U1042, Grenoble, France; CHU de Grenoble, Laboratoire EFCR, Secteur Physiologie Sommeil et Exercice, Pole Thorax et Vaisseaux Grenoble, France
| | - Jean-Louis Pepin
- Université Grenoble Alpes, HP2, Inserm U1042, Grenoble, France; CHU de Grenoble, Laboratoire EFCR, Secteur Physiologie Sommeil et Exercice, Pole Thorax et Vaisseaux Grenoble, France.
| |
Collapse
|