EFFECT OF CONTINUOUS POSITIVE

AIRWAY PRESSURE ON LIPID PROFILE IN

PATIENTS WITH OBSTRUCTIVE SLEEP
APNEA SYNDROME: A META-ANALYSIS OF
RANDOMIZED CONTROLLED TRIALS
EFFECT OF CONTI NUOUS POSI TIVE AI RWAY PRESSURE ON LI PI D
PROFI LE I N PATI ENTS WI TH OBSTRUCTI VE SLEEP APNEA
SYNDROME
Atherosclerosis
234 (2014)
446-453
Authors:
Otolaryngolog
y Institute of
Shanghai Jiao
Tong
University
Huajun Xu,
Hongliang
Yi, Jian
Guan,
Shankai Yin
Effect of continuous positive airway pressure on lipid profile in patients with obstructive sleep apnea syndrome: A meta-analysis of randomized controlled trials. Xu, Huajun et al. Atherosclerosis , Volume
234 , Issue 2 , 446 - 453
Obstructi ve sl eep apnea syndrome (OSAS) i s an i ndependent ri sk factor for
development of dyslipidemia.

Conti nuous posi ti ve ai rway pressure (CPAP) i s the fi rst -l i ne treatment for
OSAS.

However, i t i s uncl ear whether CPAP i mproves l i pi d metabol i sm.

Obj ecti ve: To revi ew the effect of CPAP on l i pi d profi l e of pati ents wi th
OSAS.
Introduction
Materials and methods
Search strategy and selection of trails
It was
systematically
searched in
PubMed, Embase,
and the Cochrane
library
All pre-September
2013 literature
examining the
effects of
CPAP on blood
lipid profiles was
included
No language or
other
restriction was
imposed.

1. Only adults (aged 18 years) with newly diagnosed OSAS were
studied.

2. CPAP was applied.

3. The duration of CPAP therapy was 2 weeks.

4. The level of at least one of TC, TG, LDL, or HDL was measured
both before and after application of CPAP
Inclusion criteria
1. Revi ews, abstracts, case reports, l etters, and non-human studi es were
excluded.

2. Treatment of adol escents (age < 18 years).

3. Di agnosis of OSAS i n a manner other than by determi nation of the AHI
(AHI 5) or the oxygen desaturati on i ndex (ODI) (ODI 7.5).

4. Fai l ure to record l i pi d l evel s both before and after CPAP therapy, or the
inadequacy of suppli ed i nformation i n terms of all owing such val ues to be
esti mated.

5. A durati on of therapy of l ess than 2 weeks.
Exclusion criteria


It was evaluated the quality of each study with the Jadad score.

Quality was independently assessed by two investigators. If
disagreement arose, a third reviewer participated in resolution of the
issue by discussion.

Quality assessment and Data extraction
Data extracted:

The fi rst author; year of publ i cati on, the country i n whi ch the work was performed
Study desi gn; number of subj ects; sex, age, body mass i ndex (BMI), and AHI or
ODI val ues of the parti ci pants.
The durati on of CPAP i nterventi on; the extent of adherence to CPAP.
Post-i nterventi on TC, TG, LDL, HDL, wei ght, BMI, systol i c bl ood pressure (SBP),
di astol i c bl ood pressure (DBP), fasti ng gl ucose, and/or homeostasi s model
assessment of i nsul i n resi stance (HOMA-IR).
The mean di fferences i n the l evel s of TC, TG, LDL, HDL, and wei ght, BMI, SBP,
DBP, fasti ng gl ucose, HOMA-IR between the test and control groups.


Results
Effect of continuous positive airway pressure on lipid profile in patients with obstructive sleep apnea syndrome: A meta-analysis of randomized controlled trials. Xu, Huajun et al. Atherosclerosis , Volume
234 , Issue 2 , 446 - 453
TC
TG
LDL HDL
Effect of continuous positive airway pressure on lipid profile in patients with obstructive sleep apnea syndrome: A meta-analysis of randomized controlled trials. Xu, Huajun et al. Atherosclerosis , Volume
234 , Issue 2 , 446 - 453
Heterogeneity and publication bias
The studies were
homogeneous in nature.
However, significant
heterogeneity in TG data was
evident
The Beggs and Mazumdar
rank correlation test did not
suggest the presence of
publication bias
CPAP decreased TC level, SBP, and DBP of patients with OSAS but
had no effect on BMI, HOMA-IR, or metabolism of TG, LDL, HDL, or
serum glucose

CPAP was more effective in younger (<50 years) severely obese (BMI
35 kg/m2) patients when applied for 12 weeks.

CPAP therapy had a more obvious effect on TC level when such
therapy was of long duration.
Discussion
OSAS was independently
associated with
abnormalities in lipid
levels.
Toyama, Trzepizur, Lam,
Kiely





Small sample sizes and
did not control for
confounding factors Dyslipidemia was linked to
obesity and not to OSAS
per se.
Sharma, McArdle

Few RCTs have addressed the topic of interest, and the total sample
size was relatively small.

Negative results may not have been published, creating publication
bias.

The duration of CPAP therapy (2-24 weeks) was relatively short, and
may have been inadequate to change lipid profiles.

Physical activity and consumption of a high-fat diet can affect serum lipid
levels independently of OSAS.

RCTs evaluating long-term CPAP intervention face an ethical problem,
because long-time sham CPAP treatment may have serious
consequences for OSAS patients.

Future RCTs with larger patient samples and longer follow-up durations
remain challenging.
Limitations


It was found that application of CPAP significantly reduced
the TC level, especially in younger, more obese patients,
and was associated with longer duration of CPAP application
Conclusion

GRACIAS