Cardiometabolic changes after continuous positive airway pressure for obstructive sleep apnoea: a randomised sham-controlled study
- Camilla M Hoyos1,
- Roo Killick1,
- Brendon J Yee1,2,
- Craig L Phillips1,3,
- Ronald R Grunstein2,4,
- Peter Y Liu1,5
- 1Endocrine and Cardiometabolic Research Group, NHMRC Centre for Integrated Research and Understanding of Sleep (CIRUS), Woolcock Institute of Medical Research, University of Sydney, Glebe, Australia
- 2Sleep and Circadian Research Group, NHMRC Centre for Integrated Research and Understanding of Sleep (CIRUS), Woolcock Institute of Medical Research, University of Sydney, Glebe, Australia
- 3Royal North Shore Hospital, Sydney, Australia
- 4Royal Prince Alfred Hospital, Sydney, Australia
- 5Division of Endocrinology, Department of Medicine, Harbor-UCLA Medical Center and Los Angeles Biomedical Research Institute, Torrance, California, USA
- Correspondence to Dr Peter Y Liu, Endocrine and Cardiometabolic Research Group, Woolcock Institute of Medical Research, University of Sydney, Glebe, NSW 2037, Australia;
Contributors All authors equally contributed to the concept and design of the trial. PYL and RRG obtained funding. CMH was responsible for data acquisition, statistical analysis and the preparation of the manuscript. All authors participated in the overall analysis and interpretation of the data, revision of the manuscript and provided final approval of the submitted version.
- Received 28 November 2011
- Accepted 7 April 2012
- Published Online First 5 May 2012
Rationale and objectives Impaired insulin sensitivity (ISx), increased visceral abdominal fat (VAF) and liver fat are all central components of the metabolic syndrome and characteristics of men with obstructive sleep apnoea (OSA). The reversibility of these observed changes with continuous positive airway pressure (CPAP) treatment in men with OSA has not been systematically studied in a randomised sham-controlled fashion.
Methods 65 men without diabetes who were CPAP naïve and had moderate to severe OSA (age=49±12 years, apnoea hypopnoea index (AHI)=39.9±17.7 events/h, body mass index=31.3±5.2 kg/m2) were randomised to receive either real (n=34) or sham (n=31) CPAP for 12 weeks. At 12 weeks, all subjects received real CPAP for an additional 12 weeks.
Measurements and main results Main outcomes were the change at week 12 from baseline in VAF, ISx and liver fat. Other metabolic outcomes were changes in the disposition index, total fat, and blood leptin and adiponectin concentrations. The AHI was lower on CPAP compared with sham by 33 events/h (95% CI−43.9 to −22.2, p<0.0001) after 12 weeks. There were no between-group differences at 12 weeks in VAF (−13.0 cm3, −42.4 to 16.2, p=0.37), ISx (−0.13 (min−1)(μU/ml))−1, −0.40 to 0.14, p=0.33), liver fat (−0.5 cm3, −3.8 to 2.7, p=0.74) or any other cardiometabolic parameter. At 24 weeks, ISx (3.2×104 (min−1)(μU/ml))−1, 0.9×104 to 6.0×104, p=0.009), but not VAF (−1.4 cm3, −19.2 to 16.4, p=0.87) or liver fat (−0.2 Hounsfield units, −2.4 to 2.0, p=0.83) were improved compared with baseline in the whole study group.
Conclusion Reducing visceral adiposity in men with OSA cannot be achieved with CPAP alone and is likely to require weight-loss interventions. Longer-term effects of CPAP on other cardiometabolic markers such as ISx require further investigation to fully examine time dependencies.
Trial Registration Number ACTRN12608000301369.
- Obstructive sleep apnoea
- intra-abdominal fat
- insulin resistance
- continuous positive airway pressure
- clinical epidemiology
- oxidative stress
- sleep apnoea
Funding Supported by the National Health and Medical Research Council of Australia (NHMRC) through a project grant (512498), a Centre for Clinical Research Excellence in Interdisciplinary Sleep Health (571421) and fellowships to CH, RK, CP, RRG and PYL (512057, 633161, 571179, 202916 and 511929, respectively). Sham machines were provided by Phillips Respironics.
Competing interests None.
Ethics approval Ethics approval was provided by Sydney South West Area Health Service Human Research and Ethics Committee (RPAH Zone).
Provenance and peer review Not commissioned; externally peer reviewed.