title: Adhesion molecule increases in sleep apnea: beneficial effect of positive airway pressure and moderation by obesity.
abstract: BACKGROUND
  Elevated levels of intercellular adhesion molecule 1 (ICAM-1) and vascular cell adhesion molecule 1 (VCAM-1) may contribute to cardiovascular disease and are associated with obstructive sleep apnea (OSA) and obesity. The relationship between OSA and obesity in determining ICAM-1 and VCAM-1 levels, and the effect of treatment, is unclear.
  
  
  OBJECTIVE
  Our aim was to study whether positive airway pressure (PAP) usage resulted in changes in ICAM-1 and VCAM-1 after 2 years within 309 OSA patients from the Icelandic Sleep Apnea Cohort, and determine how obesity affected such changes.
  
  
  METHODS
  The mean body mass index (BMI) was 32.4±5.1 kg m(-2); subjects had moderate-to-severe OSA (apnea-hypopnea index=45.0±20.2) and 79% were male. There were 177 full PAP users (⩾4 h per night and ⩾20 of last 28 nights), 44 partial (<4 h per night or <20 nights) and 88 nonusers.
  
  
  RESULTS
  ICAM-1 (P<0.001) and VCAM-1 (P=0.012) change was significantly different among the PAP groups. The largest ICAM-1 differences were among the most obese subjects (P<0.001). At follow-up, nonusers had increased ICAM-1 compared with decreased levels in full users. All groups had increased VCAM-1, but nonusers had a significantly larger increase than full users.
  
  
  CONCLUSIONS
  Within moderate-to-severe OSA patients, PAP usage prevents increases in adhesion molecules observed in nonusers after 2 years. For ICAM-1, the largest effect is in the most obese subjects. As OSA and obesity commonly coexist, the usage of PAP to limit increases in adhesion molecules may decrease the rate of progression of OSA-related cardiovascular disease.
authors.affiliation: 1] Center for Sleep and Circadian Neurobiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA [2] Biobehavioral Research Center, School of Nursing, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: V M
authors.initials: VM
authors.lastname: Pak
authors.affiliation: Center for Sleep and Circadian Neurobiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
authors.forename: B T
authors.initials: BT
authors.lastname: Keenan
authors.affiliation: Center for Sleep and Circadian Neurobiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
authors.forename: N
authors.initials: N
authors.lastname: Jackson
authors.affiliation: Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
authors.forename: M A
authors.initials: MA
authors.lastname: Grandner
authors.affiliation: 1] Center for Sleep and Circadian Neurobiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA [2] Division of Sleep Medicine/Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
authors.forename: G
authors.initials: G
authors.lastname: Maislin
authors.affiliation: Monell Chemical Senses Center, Philadelphia, PA, USA.
authors.forename: K
authors.initials: K
authors.lastname: Teff
authors.affiliation: 1] Center for Sleep and Circadian Neurobiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA [2] Division of Sleep Medicine/Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
authors.forename: R J
authors.initials: RJ
authors.lastname: Schwab
authors.affiliation: 1] University of Iceland, Medical Faculty, Reykjavik, Iceland [2] Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland.
authors.forename: E S
authors.initials: ES
authors.lastname: Arnardottir
authors.affiliation: 1] University of Iceland, Medical Faculty, Reykjavik, Iceland [2] Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland.
authors.forename: S
authors.initials: S
authors.lastname: Júlíusson
authors.affiliation: 1] University of Iceland, Medical Faculty, Reykjavik, Iceland [2] Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland.
authors.forename: B
authors.initials: B
authors.lastname: Benediktsdottir
authors.affiliation: 1] University of Iceland, Medical Faculty, Reykjavik, Iceland [2] Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland.
authors.forename: T
authors.initials: T
authors.lastname: Gislason
authors.affiliation: 1] Center for Sleep and Circadian Neurobiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA [2] Division of Sleep Medicine/Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
authors.forename: A I
authors.initials: AI
authors.lastname: Pack
mesh_terms: D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000097:blood / Q000503:physiopathology* / Q000517:prevention & control; D015815:Cell Adhesion Molecules / Q000097:blood*; D045422:Continuous Positive Airway Pressure; D018450:Disease Progression; D005260:Female; D006801:Humans; D018799:Intercellular Adhesion Molecule-1 / Q000097:blood; D008297:Male; D008875:Middle Aged; D009765:Obesity; D017286:Polysomnography; D020181:Sleep Apnea, Obstructive / Q000097:blood / Q000150:complications / Q000503:physiopathology*; D019010:Vascular Cell Adhesion Molecule-1 / Q000097:blood
chemical_list: D015815:Cell Adhesion Molecules; C573420:ICAM1 protein, human; D019010:Vascular Cell Adhesion Molecule-1; D018799:Intercellular Adhesion Molecule-1