Effects of CPAP on Metabolic Syndrome in Patients With OSA A Randomized Trial
Carregando...
Citações na Scopus
20
Tipo de produção
article
Data de publicação
2022
Título da Revista
ISSN da Revista
Título do Volume
Editora
ELSEVIER
Autores
FREITAS, Lunara S.
LEBKUCHEN, Adriana
CARDOZO, Karina H. M.
CARVALHO, Valdemir M.
Citação
CHEST, v.161, n.5, p.1370-1381, 2022
Resumo
BACKGROUND: OSA is associated with metabolic syndrome (MS), but it is unclear whether OSA treatment with CPAP can revert MS. RESEARCH QUESTION: Does OSA treatment with CPAP per se have effects on the MS reversibility and the associated metabolic, adiposity and vascular parameters? STUDY DESIGN AND METHODS: The TREATOSA-MS trial is a randomized placebo-controlled trial that enrolled adult patients with a recent diagnosis of MS and moderate or severe OSA (apnea-hypopnea index [AHI], >= 15 events/h) to undergo therapeutic CPAP or nasal dilator strips (placebo group) for 6 months. Before and after each intervention, we measured anthropometric variables, BP, glucose, and lipid profile. To control potential-related mechanisms and consequences, we also measured adiposity biomarkers (leptin and adiponectin), body composition, food intake, physical activity, subcutaneous and abdominal fat (visceral and hepatic fat), and endothelial function. RESULTS: One hundred patients (79% men; mean age, 48 +/- 9 years; BMI, 33 +/- 4 kg/m(2); AHI, 58 +/- 29 events/h) completed the study (n = 50 per group). The mean CPAP adherence was 5.5 +/- 1.5 h/night. After 6 months, most patients with OSA randomized to CPAP retained the MS diagnosis, but the rate of MS reversibility was higher than observed in the placebo group (18% vs 4%; OR, 5.27; 95% CI, 1.27-35.86; P = .04). In the secondary analysis, CPAP did not promote significant reductions in the individual components of MS, weight, hepatic steatosis, lipid profile, adiponectin, and leptin, but did promote a very modest reduction in visceral fat and improved endothelial function (all analyses were adjusted for baseline values). INTERPRETATION: Despite the higher rate of MS reversibility after CPAP therapy as compared with placebo, most patients retained this diagnosis. The lack of significant or relevant effects on adiposity biomarkers and depots supports the modest role of OSA in modulating MS.
Palavras-chave
CPAP, metabolic syndrome, metabolism, randomized controlled trial, sleep apnea
Referências
- Abud R, 2019, SLEEP MED, V62, P14, DOI 10.1016/j.sleep.2018.12.017
- Amaro ACS, 2012, CLINICS, V67, P469, DOI 10.6061/clinics/2012(05)11
- [Anonymous], 2000, PRACT GUID ID EV TRE
- Babio N, 2014, CAN MED ASSOC J, V186, pE649, DOI 10.1503/cmaj.140764
- Berry RB, 2020, AM ACAD SLEEP MED AA
- Boyce CJ, 2010, AM J ROENTGENOL, V194, P623, DOI 10.2214/AJR.09.2590
- Chen BX, 2021, ANN AM THORAC SOC, V18, P1717, DOI 10.1513/AnnalsATS.202101-060OC
- Chirinos JA, 2014, NEW ENGL J MED, V370, P2265, DOI 10.1056/NEJMoa1306187
- Chowdhuri S, 2016, AM J RESP CRIT CARE, V193, pE37, DOI 10.1164/rccm.201602-0361ST
- Consolim-Colombo FM, 2017, JCI INSIGHT, V2, DOI 10.1172/jci.insight.93340
- Corretti MC, 2002, J AM COLL CARDIOL, V39, P257, DOI 10.1016/S0735-1097(01)01746-6
- Craig CL, 2003, MED SCI SPORT EXER, V35, P1381, DOI 10.1249/01.MSS.0000078924.61453.FB
- Djavadkhani Y, 2015, THORAX, V70, P265, DOI 10.1136/thoraxjnl-2014-206354
- Dorkova Z, 2008, CHEST, V134, P686, DOI 10.1378/chest.08-0556
- Drager LF, 2015, THORAX, V70, P258, DOI 10.1136/thoraxjnl-2014-205361
- Drager LF, 2010, PLOS ONE, V5, DOI 10.1371/journal.pone.0012065
- Drager LF, 2010, ATHEROSCLEROSIS, V208, P490, DOI 10.1016/j.atherosclerosis.2009.08.016
- Flemons WW, 1999, SLEEP, V22, P667, DOI 10.1093/sleep/22.5.667
- Gami AS, 2007, J AM COLL CARDIOL, V49, P403, DOI 10.1016/j.jacc.2006.09.032
- Giribela CRG, 2012, CONTRACEPTION, V86, P35, DOI 10.1016/j.contraception.2011.08.017
- Grundy SM, 2005, CIRCULATION, V112, P2735, DOI 10.1161/CIRCULATIONAHA.105.169404
- Vieira JGH, 2014, ARQ BRAS ENDOCRINOL, V58, P844, DOI 10.1590/0004-2730000003347
- Hirotsu C, 2018, EUR RESPIR J, V52, DOI 10.1183/13993003.01150-2018
- Hoyos CM, 2013, THORAX, V68, P588, DOI 10.1136/thoraxjnl-2012-203074
- Hoyos CM, 2012, THORAX, V67, P1081, DOI 10.1136/thoraxjnl-2011-201420
- Iftikhar IH, 2015, J CLIN SLEEP MED, V11, P475, DOI 10.5664/jcsm.4610
- Iftikhar Imran H, 2013, Ann Am Thorac Soc, V10, P115, DOI 10.1513/AnnalsATS.201209-081OC
- Jawahar A, 2017, EUR J GASTROEN HEPAT, V29, P1389, DOI 10.1097/MEG.0000000000000972
- Jeejeebhoy Khursheed, 2017, CMAJ Open, V5, pE229, DOI 10.9778/cmajo.20160101
- JOHNS MW, 1991, SLEEP, V14, P540, DOI 10.1093/sleep/14.6.540
- Jullian-Desayes I, 2015, SLEEP MED REV, V21, P23, DOI 10.1016/j.smrv.2014.07.004
- Krieger EM, 2018, HYPERTENSION, V71, P681, DOI 10.1161/HYPERTENSIONAHA.117.10662
- Lebkuchen A, 2018, SCI REP-UK, V8, DOI 10.1038/s41598-018-29727-6
- Ma XZ, 2009, RADIOGRAPHICS, V29, P1253, DOI 10.1148/rg.295085186
- Mannato LW, 2015, SAO PAULO MED J, V133, P414, DOI 10.1590/1516-3180.2014.00533004
- MATTHEWS DR, 1985, DIABETOLOGIA, V28, P412, DOI 10.1007/BF00280883
- Mesarwi OA, 2015, SLEEP BIOL RHYTHMS, V13, P2, DOI 10.1111/sbr.12078
- Nadeem R, 2014, J CLIN SLEEP MED, V10, P1295, DOI 10.5664/jcsm.4282
- Ng SSS, 2021, AM J RESP CRIT CARE, V203, P493, DOI 10.1164/rccm.202005-1868OC
- Park S, 2019, ANN INTERN MED, V171, P875, DOI 10.7326/M19-0563
- Pena SDJ, 2020, AM J MED GENET C, V184, P928, DOI 10.1002/ajmg.c.31853
- Pepin JL, 2016, THORAX, V71, P726, DOI 10.1136/thoraxjnl-2015-207700
- Salas-Salvado J, 2008, ARCH INTERN MED, V168, P2449, DOI 10.1001/archinte.168.22.2449
- Barroso WKS, 2021, ARQ BRAS CARDIOL, V116, P516, DOI 10.36660/abc.20201238
- Stewart KJ, 2005, AM J PREV MED, V28, P9, DOI 10.1016/j.amepre.2004.09.006
- Ward LC, 2019, EUR J CLIN NUTR, V73, P194, DOI 10.1038/s41430-018-0335-3
- Yang GR, 2010, DIABETES CARE, V33, P2465, DOI 10.2337/dc10-0798
- Zota IM, 2021, J CLIN MED, V10, DOI 10.3390/jcm10184238
Coleções
Artigos e Materiais de Revistas Científicas - FM/MCP
Artigos e Materiais de Revistas Científicas - FM/MCM
Artigos e Materiais de Revistas Científicas - HC/ICHC
Artigos e Materiais de Revistas Científicas - HC/InCor
Artigos e Materiais de Revistas Científicas - LIM/63
Artigos e Materiais de Revistas Científicas - LIM/64
Carregar mais Artigos e Materiais de Revistas Científicas - FM/MCM
Artigos e Materiais de Revistas Científicas - HC/ICHC
Artigos e Materiais de Revistas Científicas - HC/InCor
Artigos e Materiais de Revistas Científicas - LIM/63
Artigos e Materiais de Revistas Científicas - LIM/64