Obstructive sleep apnoea treatment and fasting lipids: a comparative effectiveness study.
Obstructive sleep apnoea (OSA) is associated with cardiovascular disease. Dyslipidaemia has been implicated as a mechanism linking OSA with atherosclerosis, but no consistent associations with lipids exist for OSA or positive airway pressure treatment. We assessed the relationships between fasting lipid levels and obesity and OSA severity, and explored the impact of positive airway pressure treatment on 2-year fasting lipid level changes. Analyses included moderate-to-severe OSA patients from the Icelandic Sleep Apnoea Cohort. Fasting morning lipids were analysed in 613 untreated participants not on lipid-lowering medications at baseline. Patients were then initiated on positive airway pressure and followed for 2 years. Sub-classification using propensity score quintiles, which aimed to replicate covariate balance associated with randomised trials and, therefore, minimise selection bias and allow causal inference, was used to design the treatment group comparisons. 199 positive airway pressure adherent patients and 118 non-users were identified. At baseline, obesity was positively correlated with triglycerides and negatively correlated with total cholesterol, and low-density and high-density lipoprotein cholesterol. A small correlation was observed between the apnoea/hypopnoea index and high-density lipoprotein cholesterol. No effect of positive airway pressure adherence on 2-year fasting lipid changes was observed. Results do not support the concept of changes in fasting lipids as a primary mechanism for the increased risk of atherosclerotic cardiovascular disease in OSA.
Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, PA, USA Joint first authors.
Brendan T
BT
Keenan
Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, PA, USA Division of Sleep Medicine, Dept of Medicine, University of Pennsylvania, Philadelphia, PA, USA Joint first authors.
Greg
G
Maislin
Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, PA, USA Division of Sleep Medicine, Dept of Medicine, University of Pennsylvania, Philadelphia, PA, USA Division of Pulmonary, Allergy and Critical Care, Dept of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Bernie Y
BY
Sunwoo
Dept of Respiratory Medicine and Sleep, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
Erna Sif
ES
Arnardottir
Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, PA, USA.
Nicholas
N
Jackson
Dept of Clinical Biochemistry, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland.
Isleifur
I
Olafsson
Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
Sigurdur
S
Juliusson
Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, PA, USA Division of Sleep Medicine, Dept of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Richard J
RJ
Schwab
Dept of Respiratory Medicine and Sleep, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
Thorarinn
T
Gislason
Dept of Respiratory Medicine and Sleep, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland Faculty of Medicine, University of Iceland, Reykjavik, Iceland Joint senior authors.
Bryndis
B
Benediktsdottir
Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, PA, USA Division of Sleep Medicine, Dept of Medicine, University of Pennsylvania, Philadelphia, PA, USA Joint senior authors pack@mail.med.upenn.edu.
Allan I
AI
Pack
D000368:Aged; D000886:Anthropometry; D050197:Atherosclerosis / Q000097:blood / Q000175:diagnosis / Q000378:metabolism; D015992:Body Mass Index; D002318:Cardiovascular Diseases; D015331:Cohort Studies; D057186:Comparative Effectiveness Research; D045422:Continuous Positive Airway Pressure; D005215:Fasting; D005260:Female; D006801:Humans; D000860:Hypoxia / Q000378:metabolism; D007055:Iceland; D008055:Lipids / Q000097:blood / Q000737:chemistry*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000097:blood / Q000628:therapy; D064887:Observational Studies as Topic; D011312:Pressure; D012307:Risk Factors; D020181:Sleep Apnea, Obstructive / Q000097:blood / Q000628:therapy*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
D008055:Lipids