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Endocrine responses during CPAP withdrawal in obstructive sleep apnoea: data from two randomised controlled trials
  1. Sira Thiel1,
  2. Sarah R Haile2,
  3. Mirko Peitzsch3,
  4. Esther I Schwarz1,
  5. Noriane A Sievi1,
  6. Salome Kurth1,
  7. Felix Beuschlein4,5,
  8. Malcolm Kohler1,6,
  9. Thomas Gaisl1
  1. 1 Department of Pulmonology and Sleep Disorders Centre, University Hospital Zurich, Zurich, Switzerland
  2. 2 Department of Epidemiology, Biostatistics, and Prevention Institute, University of Zurich, Zurich, Switzerland
  3. 3 Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
  4. 4 Department of Endocrinology, Diabetology and Nutrition, University Hospital Zurich, Zurich, Switzerland
  5. 5 Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, Germany
  6. 6 Centre for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
  1. Correspondence to Dr Thomas Gaisl, Department of Pulmonology, University Hospital Zurich, Raemistrasse 100, Zurich, Switzerland; thomas.gaisl{at}


The aim of this investigation was to elucidate the effect of CPAP withdrawal on neurometabolic and cardiometabolic markers in patients with obstructive sleep apnoea. We evaluated 70 patients (mean age 61±10 years, 82% men) treated with CPAP in two 2-week, parallel, randomised controlled trials. CPAP withdrawal resulted in elevated 3,4-dihydroxyphenylglycol, norepinephrine and cortisol after 2 weeks of CPAP withdrawal; however, no statistically significant changes of the renin–angiotensin–aldosterone system (RAAS) determinants were documented. In summary, CPAP withdrawal may be more prominently linked to short-term increases in sympathetic activation than hypothalamic–pituitary–adrenal axis or RAAS activation. Identifier: NCT02493673 and NCT02050425.

  • Obstructive sleep apnoea
  • continuous positive airway pressure
  • catecholamines
  • sympathetic activity
  • cardiovascular

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  • MK and TG are joint senior authors.

  • Contributors Conception and design: TG, MK, ST. Funding: MK. Trial conduct: ST, EIS, TG, NAS. Analysis and interpretation of data: ST, SRH, MP, EIS, SK, FB, MK, TG. Drafting the article: ST. Revising the article for important intellectual content and final approval: all authors.

  • Funding This study was supported by grants from the Swiss National Science Foundation grants (grant nos. 32003B_143365/1, CR23I2_149617), Lunge Zurich, the University of Zurich Clinical Research Priority Program Sleep and Health and a Marie Curie European Reintegration Grant within the 7th European Community Framework Programme.

  • Disclaimer The funding sources had no role in the design and conduct of the study; in the collection, analysis and interpretation of the data; nor in the preparation, review or approval of the manuscript.

  • Competing interests MK reports grants from University of Zurich, grants from Lunge Zurich, during the conduct of the study; grants from Bayer AG (consultancy), outside the submitted work. TG reports grants from Bayer AG (consultancy), outside the submitted work.

  • Patient consent for publication Not required.

  • Ethics approval The initial trials were approved by the local Ethics Committee (KEK-ZH nos. 2014-0684 and 2013-0536).

  • Provenance and peer review Not commissioned; externally peer reviewed.

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