Long-term positive airway pressure therapy is associated with reduced total cholesterol levels in patients with obstructive sleep apnea: data from the European Sleep Apnea Database (ESADA).,Sleep Medicine

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Long-term positive airway pressure therapy is associated with reduced total cholesterol levels in patients with obstructive sleep apnea: data from the European Sleep Apnea Database (ESADA).
Sleep Medicine ( IF 3.8 ) Pub Date : 2020-03-07 , DOI: 10.1016/j.sleep.2020.02.023
Canan Gunduz ₁ , Ozen K Basoglu ₂ , John Arthur Kvamme ₃ , Johan Verbraecken ₄ , Ulla Anttalainen ₅ , Oreste Marrone ₆ , Paschalis Steiropoulos ₇ , Gabriel Roisman ₈ , Pavol Joppa ₉ , Holger Hein ₁₀ , Georgia Trakada ₁₁ , Jan Hedner ₁₂ , Ludger Grote ₁₂ ,

Affiliation

Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey; Ege University, Department of Chest Diseases, Izmir, Turkey.
Ege University, Department of Chest Diseases, Izmir, Turkey.
Sleep Laboratory, ENT Department, Førde Central Hospital, Førde, Norway.
Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital and University of Antwerp, Antwerp, Belgium.
Division of Medicine, Department of Pulmonary Diseases, Turku University Hospital, Turku, Finland; Hospital and Sleep Research Centre, Department of Pulmonary Diseases and Clinical Allergology, University of Turku, Finland.
CNR, Istituto per la Ricerca e l'Innovazione Biomedica, Palermo, Italy.
Sleep Unit, Department of Pneumonology, Democritus University of Thrace, Alexandroupolis, Greece.
Sleep Disorders Center, Antoine-Beclere Hospital, Clamart, France.
Department of Respiratory Medicine and Tuberculosis, Faculty of Medicine, P.J. Safarik University and L. Pasteur University Hospital, Kosice, Slovakia.
Sleep Disorders Center, Johanniter-Krankenhaus, Geesthacht, Germany.
Division of Pulmonology, Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Alexandra Hospital, Athens, Greece.
Center for Sleep and Vigilance Disorders, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden; Sleep Disorders Center, Pulmonary Department, Sahlgrenska University Hospital, Gothenburg, Sweden.

Background and aim

Obstructive sleep apnea (OSA) is an independent risk factor for dyslipidemia. The current study examined the effects of positive airway pressure (PAP) treatment on lipid status in the European Sleep Apnea Database (ESADA).

Methods

The prospective cohort study enrolled 1564 OSA subjects (74% male, mean age 54 ± 11y, body mass index (BMI) 32.7 ± 6.6 kg/m² and apnea-hypopnea index (AHI) 40.3 ± 24.4 n/h) undergoing PAP therapy for at least three months (mean 377.6 ± 419.5 days). Baseline and follow-up total cholesterol (TC) from nine centers were analyzed. Repeated measures and logistic regression tests (adjusted for age, sex, weight changes, lipid lowering medication, PAP compliance, and treatment duration) were used to compare changes in TC concentration. Incident risk for a coronary heart disease event (CHD) was used to compute a Framingham CHD risk score (estimated from age, BMI, blood pressure, and TC).

Results

Adjusted means of TC decreased from 194.2 mg/dl to 189.3 mg/dl during follow-up (p = 0.019). A clinically significant (10%) reduction of TC at PAP follow-up was observed in 422 patients (27%). Duration of PAP therapy was identified as independent predictor for TC reduction, which implies an approximately 10% risk reduction for incident CHD events (from 26.7% to 24.1% in men and from 11.2% to 10.1% in women, p < 0.001 respectively).

Conclusion

This observational study demonstrates a reduction of TC after long-term PAP treatment. The close association between TC concentration and cardiovascular (CV) mortality suggests that identification and treatment of OSA may have a beneficial effect on overall CV risk due to this mechanism. This possibility needs to be evaluated in prospective randomized studies.

中文翻译：

长期气道正压通气治疗与阻塞性睡眠呼吸暂停患者总胆固醇水平降低有关：来自欧洲睡眠呼吸暂停数据库（ESADA）的数据。

背景和目标

阻塞性睡眠呼吸暂停（OSA）是血脂异常的独立危险因素。当前的研究在欧洲睡眠呼吸暂停数据库（ESADA）中检查了气道正压（PAP）治疗对血脂状况的影响。

方法

这项前瞻性队列研究纳入了接受PAP治疗的1564位OSA受试者（男性74％，平均年龄54±11y，体重指数（BMI）32.7±6.6 kg / m ²和呼吸暂停低通气指数（AHI）40.3±24.4 n / h）至少三个月（平均377.6±419.5天）。分析了来自9个中心的基线和随访总胆固醇（TC）。重复测量和逻辑回归测试（针对年龄，性别，体重变化，降脂药物，PAP依从性和治疗持续时间进行调整）用于比较TC浓度的变化。冠心病事件（CHD）的事件风险用于计算Framingham CHD风险评分（根据年龄，BMI，血压和TC估算）。

结果

在随访期间，调整后的TC平均值从194.2 mg / dl降至189.3 mg / dl（p = 0.019）。在422例患者中（27％）观察到PAP随访时TC的临床显着降低（10％）。PAP治疗的持续时间被确定为TC降低的独立预测因素，这意味着发生冠心病事件的风险降低了约10％（男性从26.7％降低到24.1％，女性从11.2％降低到10.1％，p <0.001）。