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Effects of Continuous Positive Airway Pressure on Early Signs of Atherosclerosis in Obstructive Sleep Apnea

¹ Hypertension Unit and ² Sleep Laboratory, Pulmonary Division, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil

Correspondence and requests for reprints should be addressed to Luciano F. Drager, M.D., Hypertension Unit–Heart Institute (InCor), University of São Paulo Medical School, Av Dr Enéas Carvalho de Aguiar, 44, CEP 05403-904 São Paulo, Brazil. E-mail: luciano.drager{at}incor.usp.br

Rationale: Obstructive sleep apnea (OSA) is associated with adverse cardiovascular outcomes, including myocardial infarction and stroke. Atherosclerosis is a key mechanism for these cardiovascular events. Recent cross-sectional studies showed the presence of early signs of atherosclerosis in patients with OSA who were free of comorbidities.

Objectives: To determine the impact of treatment with continuous positive airway pressure (CPAP) on atherosclerosis.

Methods: We randomly assigned 24 patients with severe OSA (age, 46 ± 6 yr) who were free of comorbidities to receive no treatment (control, n = 12) or CPAP (n = 12) for 4 months. Carotid intima-media thickness, arterial stiffness (evaluated by pulse-wave velocity), carotid diameter, 24-hour blood pressure monitoring, C-reactive protein, and catecholamines were determined at baseline and after 4 months.

Measurements and Main Results: At baseline, all measurements were similar in both groups and did not change in the control group after 4 months. In contrast, a significant decrease occurred in carotid intima-media thickness (707 ± 105 vs. 645 ± 95 µm, P = 0.04), pulse-wave velocity (10.4 ± 1.0 vs. 9.3 ± 0.9 m/s, P < 0.001), C-reactive protein (3.7 ± 1.8 vs. 2.0 ± 1.2 mg/L, P = 0.001), and catecholamines (365 ± 125 vs. 205 ± 51 ng/ml, P < 0.001) after 4 months of CPAP. Carotid diameter did not change significantly. Regarding the whole group, changes in carotid intima-media thickness were correlated with changes in catecholamines (r = 0.41, P < 0.05). Changes in pulse-wave velocity were correlated with changes in C-reactive protein (r = 0.58, P < 0.01) and catecholamines (r = 0.54, P < 0.01).

Conclusions: The treatment of OSA significantly improves early signs of atherosclerosis, supporting the concept that OSA is an independent risk factor for atherosclerosis.

Clinical trial registered with www.clinicaltrials.gov (NCT 00400543).

Key Words: obstructive sleep apnea • intima-media thickness • arterial stiffness • atherosclerosis • continuous positive airway pressure

AT A GLANCE COMMENTARY Scientific Knowledge on the Subject Obstructive sleep apnea (OSA) is associated with increased risk of myocardial infarction and stroke. OSA has been associated with atherosclerosis, a key mechanism for these cardiovascular events. What This Study Adds to the Field This randomized study showed that effective treatment of OSA with continuous positive airway pressure for 4 months significantly improves early signs of atherosclerosis in patients with severe OSA. These results suggest that OSA is an independent risk factor for atherosclerosis.

 

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