CPAP treatment in the coexistence of obstructive sleep apnea syndrome and metabolic syndrome, results of one year follow up

Effects of different treatments on metabolic syndrome in patients with obstructive sleep apnea: a meta-analysis

Background

Obstructive sleep apnea (OSA) and metabolic syndrome (MetS) often coexist, and the causal relationship between them is not yet clear; treatments for OSA include continuous positive airway pressure (CPAP), mandibular advancement device (MAD), surgery, and lifestyle intervention and so on. However, the effects of different treatments on metabolic syndrome in OSA patients are still under debate.

Objectives

Review the effects of different treatments on metabolic syndrome in OSA patients by meta-analysis.

Methods

we searched articles in PubMed, Embase, Cochrane Library, CNKI, CBM, and Wanfang data from database construction to Feb. 2024.RevMan5.4 and Stata software were used to conduct a meta-analysis of 22 articles.

Results

A total of 22 articles were finally included. The results showed that CPAP treatment could reduce the prevalence of metabolic syndrome in OSA patients in randomized controlled trials (RCTs) (RR = 0.82 [95% CI, 0.75 to 0.90]; p < 0.01) and single-arm studies (RR = 0.73 [95% CI, 0.63 to 0.84]; p < 0.01). As for metabolic syndrome components, CPAP treatment reduces blood pressure, fasting glucose (FG), triglycerides (TG), and waist circumference (WC) but can't affect high-density lipoprotein cholesterol (HDL-C) levels. Lifestyle intervention could significantly reduce the prevalence of metabolic syndrome in OSA patients (RR = 0.60 [95% CI, 0.48 to 0.74]; p < 0.01) and can lower blood pressure, fasting glucose, and waist circumference but can't affect the lipid metabolism of OSA patients. Upper airway surgery can only reduce TG levels in OSA patients (MD = -0.74 [95% CI, -1.35 to -0.13]; p = 0.02) and does not affect other components of metabolic syndrome. There is currently no report on the impact of upper airway surgery on the prevalence of metabolic syndrome. No study has reported the effect of MAD on metabolic syndrome in OSA patients.

Conclusion

We confirmed that both CPAP and lifestyle intervention can reduce the prevalence of MetS in OSA patients. CPAP treatment can lower blood pressure, fasting glucose, waist circumference, and triglyceride levels in OSA patients. Lifestyle intervention can lower blood pressure, fasting glucose, and waist circumference in OSA patients. Upper airway surgery can only reduce TG levels in OSA patients.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022326857.

Obstructive sleep apnoea as a risk factor for incident metabolic syndrome: a joined Episono and HypnoLaus prospective cohorts study

Cross-sectional studies have demonstrated that obstructive sleep apnoea (OSA) and metabolic syndrome (MetS) are often associated, but whether a temporal relationship exists is unknown. We aimed to investigate the effect of OSA on the risk of developing MetS in the general population.A prospective study was conducted combining two population-based samples: Episono (Brazil) and HypnoLaus (Switzerland). MetS was assessed according to unified criteria. Polysomnography (PSG) was performed at baseline and follow-up in Episono, and at baseline in HypnoLaus. OSA was defined according to the apnoea-hypopnoea index as mild (≥5- <15 events h^-1) and moderate-to-severe (≥15 events·h^-1). We included 1853 participants (mean±sd age 52±13 years, 56% female) without MetS at baseline.After mean±sd 6±1 years, 318 (17.2%) participants developed MetS. Moderate-to-severe OSA was independently associated with incident MetS (OR 2.58, 95% CI 1.61-4.11) and increased the number of MetS components from baseline to follow-up through mediation of the percentage of time with arterial oxygen saturation <90%. Subset analysis in Episono confirmed that the increase in this parameter between baseline and follow-up PSGs represented a risk factor for incident MetS (OR 1.42, 95% CI 1.04-1.95, for each 10% increase).OSA is independently associated with an increased risk of developing MetS through mediation of nocturnal hypoxaemia in the general population.

Effect of continuous positive airway pressure on type 2 diabetes mellitus and glucose metabolism

BACKGROUND

Obstructive sleep apnea (OSA) is a prevalent condition that is associated with significant comorbidities, including obesity, hypertension, cardiovascular disease, and insulin resistance. Continuous positive airway pressure (CPAP) is an effective treatment for OSA. The effect of CPAP on glucose metabolism in patients with OSA has been controversial. This study evaluates the impact of CPAP on patients with OSA and type 2 diabetes mellitus (T2DM) or prediabetes.

MATERIALS AND METHODS

PubMed, Ovid Medline, and EMBASE were searched for original English language studies performed on or after 2003. Subjects were aged > 18 years, were diagnosed with OSA via polysomnography, and had either T2DM or prediabetes according to laboratory evaluation.

RESULTS

Of the 22 articles that met the selection criteria, 17 studies (77%) showed that a prolonged use of CPAP produced significant changes in glucose metabolism of patients who had T2DM and prediabetes. These changes were observed in studies measuring glycosylated hemoglobin (HbA1c), postprandial or nocturnal glucose, and insulin sensitivity or resistance. Of the 17 studies, 4 showed improvement in HbA1c levels or increased insulin sensitivity only after long-term use of CPAP for ≥ 3 months.

CONCLUSION

This literature review shows that CPAP improves not only hypoxia while restoring normal breathing during sleep, but also glucose metabolism in patients with OSA and T2DM or prediabetes. A few studies have shown that patients can experience even better results with long-term CPAP treatment (≥ 3 months of daily use) for > 4 hours a night. Therefore, this improvement in glucose metabolism with the use of CPAP may contribute to T2DM prevention and decrease further progression of the disease. However, additional studies are needed to confirm these findings.

Obstructive sleep apnea syndrome is associated with metabolic syndrome and inflammation

Obstructive sleep apnea (OSA) is an independent risk factor for cardiovascular morbidity and mortality. However, the underlying mechanism is unclear. In this cross-sectional study, we investigated the influence of OSA on metabolic syndrome (MetS) and inflammation, which were considered as cardiovascular risks. A total of 144 consecutive male patients who underwent standard polysomnography were enrolled. Fasting blood samples were obtained from all patients for glucose, high-sensitivity C-reactive protein (hs-CRP) and lipids measurement. A metabolic score was established as the total number of the positive diagnostic criteria of metabolic syndrome for each patient. Systolic blood pressure, diastolic blood pressure, fasting glucose, hs-CRP and metabolic score significantly increased with the aggravation of OSA severity. Metabolic score increased from 1.74 ± 1.20 to 2.89 ± 0.99 with OSA severity (p = 0.000). hs-CRP increased from 0.68 (0.43-1.10) to 1.44 (0.62-4.02) mg/L with OSA severity (p = 0.002). After adjustment for confounders, apnea-hypopnea index and body mass index (BMI) were the major contributing factors for metabolic score (β = 0.257, p = 0.003 and β = 0.344, p = 0.000, respectively), lowest O2 saturation and BMI were the independent predictors of hs-CRP (β = -0.255, p = 0.003 and β = 0.295, p = 0.001, respectively). OSA is independently associated with sum of metabolic components and hs-CRP.

Obstructive sleep apnea hypopnea syndrome and metabolic syndrome: a synergistic cardiovascular risk factor

PURPOSE

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality for adults in the United States. One risk factor for CVD is metabolic syndrome, which encompasses obesity, hypertension, insulin resistance, proinflammatory state, and prothrombotic state. A lesser-understood risk factor is obstructive sleep apnea hypopnea syndrome (OSAHS). This article explores the physiological consequences of the interaction between OSAHS and metabolic syndrome on the cardiovascular system.

DATA SOURCES

Search terms "metabolic syndrome,""obstructive sleep apnea,""cardiovascular disease,""diabetes,""obesity," and "atherosclerosis," were used. Studies involving children were excluded.

CONCLUSIONS

Both metabolic syndrome and OSAHS have significant impact on the cardiovascular system; however, when both conditions are present together, the impact is synergistic and CVD risk is multiplied. Treatment with continuous positive airway pressure (CPAP) reduces the global burden of CVD risk.

IMPLICATIONS FOR PRACTICE

Providers need to screen patients routinely for both metabolic syndrome and OSAHS. Treatment should include CPAP, weight reduction, oral appliances, and/or upper airway surgeries with concurrent management for metabolic syndrome. Future research should further elucidate the mechanisms of action by which OSAHA and metabolic syndrome contribute to CVD. This understanding can lead to more stringent guidelines on the management of metabolic syndrome and OSAHS.

Obstructive sleep apnea and type 2 diabetes: is there a link?

Type 2 diabetes is a chronic illness that is increasing in epidemic proportions worldwide. Major factors contributing to the development of type 2 diabetes include obesity and poor lifestyle habits (e.g., excess dietary intake and limited physical activity). Despite the proven efficacy of lifestyle interventions and the use of multiple pharmacological agents, the economic and public health burden of type 2 diabetes remains substantial. Obstructive sleep apnea (OSA) is a treatable sleep disorder that is pervasive among overweight and obese adults, who represent about two thirds of the U.S. population today. An ever-growing number of studies have shown that OSA is associated with insulin resistance, glucose intolerance and type 2 diabetes, independent of obesity. Evidence from animal and human models that mimic OSA provides potential mechanisms for how OSA may alter glucose metabolism. Up to 83% of patients with type 2 diabetes suffer from unrecognized OSA and increasing severity of OSA is associated with worsening glucose control. However, it is still unclear whether OSA may lead to the development of diabetes over time. More data from large-scale longitudinal studies with rigorous assessments of diabetes and OSA are needed. In addition, there is still controversy whether continuous positive airway pressure (CPAP) treatment of OSA improves glucose metabolism. Large-scale randomized-controlled trials of CPAP treatment of OSA with well-validated assessments of insulin sensitivity and glucose tolerance are needed. These studies may reveal that OSA represents a novel, modifiable risk factor for the development of prediabetes and type 2 diabetes.

Obesity, obstructive sleep apnoea and metabolic syndrome

OSA is increasingly recognized as a major health problem in developed countries. Obesity is the most common risk factor in OSA and hence, the prevalence of OSA is undoubtedly rising given the epidemic of obesity. Recent data also suggest that OSA is highly associated with the metabolic syndrome, and it is postulated that OSA contributes to cardiometabolic dysfunction, and subsequently vasculopathy. Current evidence regarding the magnitude of impact on ultimate cardiovascular morbidity or mortality attributable to OSA-induced metabolic dysregulation is scarce. Given the known pathophysiological triggers of intermittent hypoxia and sleep fragmentation in OSA, the potential mechanisms of OSA-obesity-metabolic syndrome interaction involve sympathetic activation, oxidative stress, inflammation and neurohumoral changes. There is accumulating evidence from human and animal/cell models of intermittent hypoxia to map out these mechanistic pathways. In spite of support for an independent role of OSA in the contribution towards metabolic dysfunction, a healthy diet and appropriate lifestyle modifications towards better control of metabolic function are equally important as CPAP treatment in the holistic management of OSA.

Obstructive sleep apnea and pregnancy: the effect on perinatal outcomes

Obstructive sleep apnea (OSA) is characterized by repeated episodes of upper airway obstruction, resulting in hypoxemia, hypercapnia and sleep fragmentation. Pathophysiological sequelae include sympathetic activation, increased oxidative stress and a generalized inflammatory response, culminating in endothelial dysfunction. These are the proposed mechanisms that mediate the increased risk of hypertension and cardiovascular disease among patients with OSA outside of pregnancy. It is intriguing to consider the consequences of these events on pregnancy outcomes. There is a growing literature on the impact of maternal OSA on hypertensive disorders of pregnancy, gestational diabetes and impaired fetal growth. The data, while promising, require confirmation with larger numbers to verify the findings. OSA may be an important mediator of the poor perinatal outcomes associated with maternal obesity; moreover, one which may be amenable to treatment. This review discusses OSA and summarizes the current literature linking OSA with adverse perinatal outcomes.

Effect of continuous positive airway pressure therapy on glucose control

Obstructive sleep apnea (OSA) and diabetes mellitus are both highly prevalent disorders. There has been a recent recognition of an association between insulin resistance and sleep apnea. Continuous positive airway pressure (CPAP) has emerged as an effective therapy for treatment of OSA and has been shown to positively influence numerous pathophysiological factors that contribute to cardiovascular risk. There is emerging data that explores the influence of CPAP therapy, insulin sensitivity and glycemic control. In the current review, we examine this literature critically and formulate a synopsis that summarizes the current knowledge in this field.

Continuous positive airway pressure treatment: effect on serum lipids in patients with obstructive sleep apnoea

Obstructive Sleep Apnoea (OSA) is a common disorder in adults. Its hallmark is repetitive episodes of partial or complete obstruction of the upper airway during sleep associated with increasing respiratory efforts. This leads to oxyhaemoglobin desaturation, sleep fragmentation, and daytime symptoms, mainly excessive sleepiness. Accumulating evidence suggests that intermittent hypoxia and oxyhaemoglobin desaturation may, irrespective of obesity, lead to elevation of serum lipids even in non-dyslipidaemic OSA patients. Continuous Positive Airway Pressure (CPAP) is the treatment of choice for OSA, since it eliminates upper airway collapse during sleep and improves sleep fragmentation, daytime symptoms and quality of life. Moreover, it has been proposed that the amelioration of breathing disturbances during sleep can improve several markers of the lipid profile, such as total cholesterol, triglycerides, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol as well as apolipoproteins A, B and C. Indeed, some studies have reported improvements in these parameters especially in CPAP adherent patients. However, other studies failed to confirm this beneficial effect. The present article reviews the issue whether CPAP treatment exerts a beneficial effect on lipids.

Sleep and metabolic function

Evidence for the role of sleep on metabolic and endocrine function has been reported more than four decades ago. In the past 30 years, the prevalence of obesity and diabetes has greatly increased in industrialized countries, and self-imposed sleep curtailment, now very common, is starting to be recognized as a contributing factor, alongside with increased caloric intake and decreased physical activity. Furthermore, obstructive sleep apnea, a chronic condition characterized by recurrent upper airway obstruction leading to intermittent hypoxemia and sleep fragmentation, has also become highly prevalent as a consequence of the epidemic of obesity and has been shown to contribute, in a vicious circle, to the metabolic disturbances observed in obese patients. In this article, we summarize the current data supporting the role of sleep in the regulation of glucose homeostasis and the hormones involved in the regulation of appetite. We also review the results of the epidemiologic and laboratory studies that investigated the impact of sleep duration and quality on the risk of developing diabetes and obesity, as well as the mechanisms underlying this increased risk. Finally, we discuss how obstructive sleep apnea affects glucose metabolism and the beneficial impact of its treatment, the continuous positive airway pressure. In conclusion, the data available in the literature highlight the importance of getting enough good sleep for metabolic health.

Cardiovascular disease risk reduction with sleep apnea treatment

Cardiovascular diseases are the leading cause of death among adults in developed countries. An increase in prevalent cardiovascular risk factors (e.g., obesity, hypertension and diabetes) has led to a concerted effort to raise awareness of the need to use evidence-based strategies to help patients at risk of developing cardiovascular disease and to reduce their likelihood of suffering a stroke. Sleep apnea has emerged as an important risk factor for the development of cardiovascular disease. Epidemiologic and clinical evidence has prompted the American Heart Association to issue a scientific statement describing the need to recognize sleep apnea as an important target for therapy in reducing cardiovascular disease risks. This article examines evidence supporting associations of sleep apnea with cardiovascular disease and considers evidence suggesting cardiovascular risk reductions through sleep apnea treatment. Perspectives on emerging therapeutic approaches and promising areas of clinical and experimental research are also discussed.

APAP impact on metabolic syndrome in obstructive sleep apnea patients

PURPOSE

Prevalence of metabolic syndrome (MS) in obstructive sleep apnea (OSA) patients is high. The effect of autoadjusting positive airway pressure (APAP) on MS remains unclear. This study aimed to determine the prevalence of MS in OSA patients before and 6 months after APAP, and to identify potential determinants of metabolic status change.

METHODS

Seventy-four male patients with moderate to severe OSA were enrolled. MS diagnosis was established according to the National Cholesterol Education Program/Adult Treatment Panel III. APAP was prescribed to all patients.

RESULTS

In the studied population, mean age was 55.9 years (SD 10.7 years), median body mass index (BMI), Epworth sleepiness scale (ESS), and respiratory disturbance index (RDI) were 33.4 kg/m(2) (interquartile range (IQR) 8.4 kg/m(2)), 12.0 (IQR 8.0), and 46.9/h (IQR 33.6/h), respectively. Prevalence of MS before and 6 months after APAP was 63.5% and 47.3%, respectively, and this difference was statistically significant (p = 0.004). In the subgroup of patients with MS at baseline (n = 47), 14 did not present MS after APAP. In these patients, a significant negative association with RDI (p = 0.016) and a positive association with percent of total days of usage (p = 0.014) were found. Blood pressure (p = 0.018) and serum triglycerides (p = 0.001) had a statistically significant reduction during this period. In patients that still had MS, 22.2% presented a reduction of the number of MS criteria.

CONCLUSIONS

After 6 months, APAP reduced the prevalence of MS, mainly in patients with less severe OSA and with a better therapeutic compliance. Blood pressure and serum triglycerides reduction contributed to this metabolic status change.