期刊報告-101.5-陳清文

CPAP for the Metabolic Syndrome in Patients with Obstructive Sleep Apnea

Surendra K. Sharma, Swastik Agrawal, Deepak Damodaran, Vishnubhatla Sreenivas, Tamilarasu Kadhiravan, Ramakrishnan Lakshmy, Priya Jagia, and Atin Kumar

NEJM 2011,365,24：2277-2286

Abstr act

Background

Obstructive sleep apnea is associated with an increased prevalence of the metabolic syndrome and its components. It is unclear whether treatment of obstructive sleep apnea syndrome with continuous positive airway pressure (CPAP) would modify these outcomes.

Methods

In our double-blind, placebo-controlled trial(RCT), we randomly assigned patients with obstructive sleep apnea syndrome to undergo 3 months of therapeutic CPAP followed by 3 months of sham CPAP, or vice versa, with a washout period of 1 month in between. Before and after each intervention, we obtained measurements of anthropometric variables, blood pressure, fasting blood glucose levels, insulin resistance (with the use of homeostasis model assessment), fasting blood lipid profile, glycated hemoglobin levels, carotid intima–media thickness(CIMT), and visceral fat. The metabolic syndrome was defined according to National Cholesterol Education Program Adult Treatment Panel III criteria, with Asian cutoff values for abdominal obesity.

Results

A total of 86 patients completed the study, 75 (87%) of whom had the metabolic syndrome. CPAP treatment (vs. sham CPAP) was associated with significant mean decreases in systolic blood pressure (3.9 mm Hg; 95% confidence interval [CI], 1.4 to 6.4; P = 0.001), diastolic blood pressure (2.5 mm Hg; 95% CI, 0.9 to 4.1; P < 0.001), serum total cholesterol (13.3 mg per deciliter; 95% CI, 5.3 to 21.3; P = 0.005), non–high density lipoprotein cholesterol (13.3 mg per deciliter; 95% CI, 4.8 to 21.8; P = 0.009), low-density lipoprotein cholesterol (9.6 mg per deciliter; 95% CI, 2.5 to 16.7; P = 0.008), triglycerides (18.7 mg per deciliter; 95% CI, 4.3 to 41.6; P = 0.02), and glycated hemoglobin (0.2%; 95% CI, 0.1 to 0.4; P = 0.003). The frequency of the metabolic syndrome was reduced after CPAP therapy (reversal found in 11 of 86 patients [13%] undergoing CPAP therapy vs. 1 of 86 [1%] undergoing sham CPAP). Accelerated hypertension developed 1 patient receiving CPAP therapy first, intolerance to CPAP developed in 2 others, and another patient declined to continue sham CPAP. Conclusions

In patients with moderate-to-severe obstructive sleep apnea syndrome, 3 months of CPAP therapy lowers blood pressure and partially reverses metabolic abnormalities.

1. OSA(OBSTRUCTIVE SLEEP APNEA)在美國的盛行率，男性為24%，女性為9%；在北印度的盛行率，男性為13.7%，女性為3.8%。


2. MS新陳代謝症候群(METABOLIC SYNDROME)是心血管疾病的危險因子，和OSA相關，有OSA的病人其MS的盛行率為74%-85%，無OSA的病人其MS的盛行率為37%-41%。


3. OSA是高血壓和insulin抗性的獨立危險因子。


4. AHI(apnea-hypopnea index)=Apnea次數(flow cessation)+hypopnea次數(partial flow obstruction)

mild 5≦AHI<15
moderate  15≦AHI<30
severe 30 ≦ AHI