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Obstructive sleep apnea syndrome (OSAS) is an I ndependent ri sk factor for development of dyslipidemia. Continuous positive airway pressure (CPAP) is the fi rst -line treatment for OSAS.
Obstructive sleep apnea syndrome (OSAS) is an I ndependent ri sk factor for development of dyslipidemia. Continuous positive airway pressure (CPAP) is the fi rst -line treatment for OSAS.
Obstructive sleep apnea syndrome (OSAS) is an I ndependent ri sk factor for development of dyslipidemia. Continuous positive airway pressure (CPAP) is the fi rst -line treatment for OSAS.
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