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Effects of Continuous Positive Airway Pressure on Systemic Inflammation in Patients with Moderate to Severe Obstructive Sleep Apnoea: a randomised controlled trial
  1. Malcolm Kohler MD (malcolm.kohler{at}orh.nhs.uk)
  1. Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford, United Kingdom
    1. Lisa Ayers (lisa_ayers82{at}yahoo.co.uk)
    1. Department of Clinical Immunology, Churchill Hospital, Oxford, United Kingdom
      1. Justin CT Pepperell, MD, FRCP (justin.pepperell{at}tst.nhs.uk)
      1. Department of Respiratory Medicine, Musgrove Park Hospital, Taunton, United Kingdom
        1. Kerri L Packwood (k.packwood{at}nhs.net)
        1. Department of Clinical Immunology, Churchill Hospital, Oxford, United Kingdom
          1. Berne Ferry MD (berne.ferry{at}orh.nhs.uk)
          1. Department of Clinical Immunology, Churchill Hospital, Oxford, United Kingdom
            1. Nicky Crosthwaite (nicky.crosthwaite{at}orh.nhs.uk)
            1. Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford, United Kingdom
              1. Sonya Craig, MRCP (sonya.craig{at}orh.nhs.uk)
              1. Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford, United Kingdom
                1. Massimiliano M Siccoli MD (massimiliano.siccoli{at}orh.nhs.uk)
                1. Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford, United Kingdom
                  1. Robert JO Davies, DM, FRCP (robert.davies{at}ndm.ox.ac.uk)
                  1. Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford, United Kingdom
                    1. John R Stradling, MD, FRCP (john.stradling{at}orh.nhs.uk)
                    1. Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford, United Kingdom

                      Abstract

                      Background: Obstructive sleep apnoea syndrome (OSAS) has been associated with cardiovascular disease in epidemiological and observational studies. Continuous positive airway pressure (CPAP) is the treatment of choice for OSAS, but the impact of this intervention on systemic inflammation involved in the atherosclerotic process remains unclear.

                      Methods: 100 men with moderate-severe OSAS were randomised to therapeutic (n=51) or subtherapeutic (n=49) CPAP treatment for 4 weeks to investigate the effects of active treatment on inflammatory markers such as highly sensitive C-reactive protein (hsCRP), IL-6, IFN-γ, and anti-inflammatory adiponectin.

                      Results: Four weeks of therapeutic CPAP did not significantly change blood levels of hsCRP compared to the subtherapeutic control group (difference between median changes -0.24 mg/L, 95% C.I. -0.88 to +0.24, p=0.30). Plasma levels of IL-6 and IFN-γ did not change significantly following therapeutic compared to subtherapeutic CPAP (difference between median changes +0.52 pg/ml and -0.07 pg/ml, 95% C.I. -0.72 to +1.94 and -0.81 to +0.44, p=0.45 and p=0.82 respectively). Furthermore, four weeks of therapeutic CPAP did not significantly change levels of adiponectin in plasma compared to the subtherapeutic control group (difference between median changes +0.05 pg/ml, 95% C.I. -0.36 to +0.47, p=0.84). If patients with hsCRP values above 8 mg/L at baseline were excluded, differences between the changes of hsCRP, IL-6, IFN-γ and adiponectin after 4 weeks of CPAP were smaller, and again not statistically different between groups.

                      Conclusions: Four weeks of CPAP treatment has no beneficial effect on blood markers of inflammation and adiponectin in patients with moderate-severe obstructive sleep apnoea.

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