title: Effects of continuous positive airway pressure on cardiovascular risk profile in patients with severe obstructive sleep apnea and metabolic syndrome.
abstract: BACKGROUND
  The increased risk of atherosclerotic morbidity and mortality in patients with obstructive sleep apnea (OSA) has been linked to arterial hypertension, insulin resistance, systemic inflammation, and oxidative stress. We aimed to determine the effects of 8 weeks of therapy with continuous positive airway pressure (CPAP) on glucose and lipid profile, systemic inflammation, oxidative stress, and global cardiovascular disease (CVD) risk in patients with severe OSA and metabolic syndrome.
  
  
  METHODS
  In 32 patients, serum cholesterol, triglycerides, high-density lipoprotein cholesterol, fibrinogen, apolipoprotein A-I, apolipoprotein B (ApoB), high-sensitivity C-reactive protein, interleukin-6, tumor necrosis factor (TNF)-alpha, leptin, malondialdehyde (MDA), and erythrocytic glutathione peroxidase (GPx) activity were measured at baseline and after 8 weeks of CPAP. The insulin resistance index (homeostasis model assessment [HOMA-IR]) was based on the homeostasis model assessment method, the CVD risk was calculated using the multivariable risk factor algorithm.
  
  
  RESULTS
  In patients who used CPAP for > or = 4 h/night (n = 16), CPAP therapy reduced systolic BP and diastolic BP (p = 0.001 and p = 0.006, respectively), total cholesterol (p = 0.002), ApoB (p = 0.009), HOMA-IR (p = 0.031), MDA (p = 0.004), and TNF-alpha (p = 0.037), and increased erythrocytic GPx activity (p = 0.015), in association with reductions in the global CVD risk (from 18.8 +/- 9.8 to 13.9 +/- 9.7%, p = 0.001). No significant changes were seen in patients who used CPAP for < 4 h/night. Mask leak was the strongest predictor of compliance with CPAP therapy.
  
  
  CONCLUSIONS
  In patients with severe OSA and metabolic syndrome, good compliance to CPAP may improve insulin sensitivity, reduce systemic inflammation and oxidative stress, and reduce the global CVD risk.
authors.affiliation: Department of Respiratory Medicine, Faculty of Medicine, P.J. Safarik University and L. Pasteur Teaching Hospital, LABMED, Kosice, Slovakia.
authors.forename: Zuzana
authors.initials: Z
authors.lastname: Dorkova
authors.affiliation: Institute of Experimental Medicine, Faculty of Medicine, LABMED, Kosice, Slovakia.
authors.forename: Darina
authors.initials: D
authors.lastname: Petrasova
authors.affiliation: Department of Biochemistry, LABMED, Kosice, Slovakia.
authors.forename: Angela
authors.initials: A
authors.lastname: Molcanyiova
authors.affiliation: Department of Biochemistry, LABMED, Kosice, Slovakia.
authors.forename: Marcela
authors.initials: M
authors.lastname: Popovnakova
authors.affiliation: Department of Respiratory Medicine, Faculty of Medicine, P.J. Safarik University and L. Pasteur Teaching Hospital, LABMED, Kosice, Slovakia. Electronic address: rtkacova@medic.upjs.sk.
authors.forename: Ruzena
authors.initials: R
authors.lastname: Tkacova
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000097:blood / Q000209:etiology*; D015331:Cohort Studies; D045422:Continuous Positive Airway Pressure; D016207:Cytokines / Q000097:blood; D005260:Female; D006801:Humans; D008055:Lipids / Q000097:blood; D008297:Male; D024821:Metabolic Syndrome / Q000097:blood* / Q000150:complications; D008875:Middle Aged; D018384:Oxidative Stress / Q000502:physiology; D010349:Patient Compliance; D012307:Risk Factors; D020181:Sleep Apnea, Obstructive / Q000097:blood* / Q000150:complications / Q000628:therapy*; D013997:Time Factors
chemical_list: D001786:Blood Glucose; D016207:Cytokines; D008055:Lipids