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(Chest. 2006;129:632-637.)
© 2006 American College of Chest Physicians

Effect of Continuous Positive Airway Pressure on Soluble CD40 Ligand in Patients With Obstructive Sleep Apnea Syndrome*

Kazuyuki Kobayashi, MD; Yoshihiro Nishimura, MD, PhD; Temiko Shimada, MD; Sho Yoshimura, MD; Yasuhiro Funada, MD, PhD; Miyako Satouchi, MD, PhD and Mitsuhiro Yokoyama, MD, PhD

* From the Division of Cardiovascular and Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Chuo-ku, Kobe, Japan.

Correspondence to: Yoshihiro Nishimura, MD, Division of Cardiovascular and Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7–5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan; e-mail: nishiy{at}med.kobe-u.ac.jp

Abstract

Background: Obstructive sleep apnea syndrome (OSAS) is an independent risk factor for atherosclerosis. CD40-CD40 ligand interaction promotes several proinflammatory mediators and plays a pivotal role in the various stages of atherosclerotic diseases. The present study examines whether CD40 ligation contributes to outcomes in patients with OSAS.

Methods: The study population comprised OSAS patients with an apnea hypopnea index (AHI) ≥ 30 (n = 35) and control subjects (AHI < 5; n = 16). We measured serum levels of soluble CD40 ligand (sCD40L), tumor necrosis factor (TNF)-{alpha}, and hypersensitive C-reactive protein (hsCRP) before and after nasal continuous positive airway pressure (nCPAP) therapy for 3 months.

Results: Baseline levels of sCD40L were significantly higher in patients with OSAS (6.93 ± 4.64 ng/mL) [mean ± SD] than in control subjects (3.43 ± 2.11 ng/mL, p < 0.01). Baseline levels of sCD40L positively correlated with TNF-{alpha} but not with hsCRP. The elevation of sCD40L was improved for 1 night after nCPAP therapy (3.83 ± 2.78 ng/mL, p < 0.001). Even though patients with severe OSAS did not receive any other medication to control atherosclerotic risk factors for 3 months, nCPAP was continued to reduce the levels of sCD40L.

Conclusion: The present study suggested that sCD40L is a key factor that links OSAS and atherosclerotic progression.

Key Words: atherosclerosis • hypoxia • obstructive sleep apnea • soluble CD40 ligand






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