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Effects of CPAP Therapy on Metabolic Syndrome in Patients with Obstructive Sleep Apnea: The TREATOSA-MS Randomized Controlled Trial
Obstructive sleep apnea (OSA) is associated with metabolic syndrome (MS), but it is unclear whether OSA treatment with continuous positive airway pressure (CPAP) can revert MS.
To evaluate the effects of 6 months of CPAP on MS reversibility rate in patients with OSA.
The TREATOSA-MS is a randomized placebo-controlled trial that enrolled adult patients with a recent diagnosis of MS (NCEP III criteria), and moderate/severe OSA (apnea-hypopnea index, AHI ≥15 events/h by polysomnography) to undergo 6 months of therapeutic CPAP or nasal dilator strips (placebo group). All patients were non-smokers and used no medications. Before and after each intervention, we measured anthropometric variables, blood pressure, metabolic and inflammatory biomarkers, endothelial function, body composition by bioimpedance, food intake, physical activity, and abdominal fat by computed tomography.
Between March 2015 and April 2019, 103 patients were recruited and randomly assigned (n=50 to placebo and n=53 to CPAP). 100 patients (79% men; age: 48±9 years; body mass index: 33±4 kg/m²; AHI: 58±29 events/h; Epworth Sleepiness Scale: 13±5) completed the study (n=50 per group). The mean CPAP adherence was 5.5±1.5 h/night. As expected, CPAP promoted significant improvements in OSA severity, hypoxemic parameters, and daytime somnolence, while only the latter was improved in the placebo group. Compared to placebo, 6 months of CPAP promoted significant MS reversibility (4% vs.18%; OR:5.27; 95% CI 1.27 to 35.86; p=0.04). Compared to baseline, the mean number of MS components were 3.7±0.6 vs. 3.8±0.8 in the placebo and 3.7±0.6 vs. 3.2±0.9 in the CPAP group (mean difference: +0.02±0.80 and -0.42±0.95, respectively; p=0.01). In the secondary analysis, CPAP did not promote significant reductions in the individual components of MS, weight, metabolic and inflammatory biomarkers, and hepatic steatosis, but improved endothelial function and promoted a very modest reduction on visceral fat (all analyses adjusted for baseline values).
In patients with MS and OSA, 6 months of CPAP therapy is able to promote a 5-fold increase chance to reverse MS. However, the lack of clinically significant effects on weight suggests that the role of OSA in modulating MS is modest. These results underscore the need for combined therapy with CPAP, aiming to maximize MS recovery in parallel with improvements in OSA severity and daytime sleepiness.
Continuous positive airway pressure; sleep apnea, obstructive; metabolic syndrome
Heart Institute (InCor), University of São Paulo Medical School - São Paulo - Brasil
Sara Quaglia Campos Giampá, Sofia Fontanello Furlan, Lunara Silva Freitas, Thiago Andrade Macedo, Franco Chies Martins, Mariana Lins Baptista, Carlos Eduardo Rochitte, Luiz Aparecido Bortolotto, Geraldo Lorenzi-Filho, Luciano Ferreira Drager