title: Change in cardio-ankle vascular index by long-term continuous positive airway pressure therapy for obstructive sleep apnea.
abstract: BACKGROUND
  It has been reported that patients with obstructive sleep apnea (OSA) have an elevated arterial stiffness, and alleviation of OSA by continuous positive airway pressure (CPAP) might attenuate this. Recently, the cardio-ankle vascular index (CAVI) has been reported to be a highly reproducible arterial stiffness parameter in OSA patients. However, the change in CAVI that occurs following long-term CPAP treatment for OSA remains unclear.
  
  
  METHODS
  Patients with moderate-to-severe OSA were enrolled. Changes in CAVI at 1 and 12 months after CPAP initiation (ΔCAVI(1) and ΔCAVI(12), respectively) were assessed. Factors associated with ΔCAVI(1) and ΔCAVI(12) were determined by multivariable regression analyses.
  
  
  RESULTS
  Thirty subjects were assessed. CAVI was significantly reduced at 1 month compared with the baseline from 7.80 ± 1.19 to 7.56 ± 1.08 (p = 0.013). A non-significant reduction was observed at 12 months (7.72 ± 1.18, p = 0.365 versus baseline) and CAVI had actually increased compared with that measured at 1 month. In multivariable analyses, ΔCAVI(1) was inversely correlated with CPAP usage (coefficient: -0.500, p = 0.006) and was directly correlated with the change in the ratio of low frequency to high frequency in heart rate variability (coefficient: 0.607, p < 0.001), whereas ΔCAVI(12) was related to the use of angiotensin-converting enzyme inhibitors (ACE-I) or angiotensin-II-receptor blockers (ARB; coefficient: 0.464, p = 0.013), was directly correlated with the change in hemoglobin A1c levels (coefficient: 0.644, p < 0.001), and was inversely correlated with the change in CPAP usage (coefficient: -0.380, p = 0.046).
  
  
  CONCLUSIONS
  CAVI was significantly reduced by short-term CPAP and then slightly increased from 1 to 12 months, which was probably due to natural progression associated with the aging process. However, long-term CPAP treatment had the beneficial effect of maintaining CAVI below baseline levels when associated with the use of ACE-I/ARB, the control of blood glucose and the CPAP compliance.
authors.affiliation: Sleep Center, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo 105-8470, Japan.
authors.forename: Mitsue
authors.initials: M
authors.lastname: Kato
authors.forename: Takiko
authors.initials: T
authors.lastname: Kumagai
authors.forename: Ryo
authors.initials: R
authors.lastname: Naito
authors.forename: Ken
authors.initials: K
authors.lastname: Maeno
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kasagi
authors.forename: Fusae
authors.initials: F
authors.lastname: Kawana
authors.forename: Sugao
authors.initials: S
authors.lastname: Ishiwata
authors.forename: Koji
authors.initials: K
authors.lastname: Narui
authors.forename: Takatoshi
authors.initials: T
authors.lastname: Kasai
mesh_terms: D000842:Ankle / Q000098:blood supply*; D001158:Arteries / Q000503:physiopathology; D045422:Continuous Positive Airway Pressure; D003935:Diagnostic Techniques, Cardiovascular; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020181:Sleep Apnea, Obstructive / Q000503:physiopathology* / Q000628:therapy*