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Fixed and Autoadjusting Continuous Positive Airway Pressure Treatments Are Not Similar in Reducing Cardiovascular Risk Factors in Patients With Obstructive Sleep Apnea^*

^* From the Division of Respiratory Rehabilitation (Drs. Patruno, Aiolfi, and Murgia), S. Marta Hospital, Rivolta d’Adda, "Ospedale Maggiore", Crema; and Department of Clinical Sciences (Drs. Costantino, Selmi, Malliani, and Montano), Internal Medicine II, L. Sacco Hospital, University of Milan, Milan, Italy.

Correspondence to: Nicola Montano, MD, PhD, Department of Clinical Sciences, L. Sacco Hospital, University of Milan, via GB Grassi 74, 20157 Milano, Italy; e-mail: nicola.montano{at}unimi.it

Abstract

Background: A strong association between obstructive sleep apnea (OSA) and the risk for cardiovascular and cerebrovascular diseases has been reported. Continuous positive airway pressure (CPAP) is the first-line therapy for OSA, able not only to reduce daytime sleepiness but also to improve cardiovascular and metabolic outcomes. Autoadjusting CPAP (APAP), an alternative treatment to CPAP, can reduce OSA symptoms while increasing long-term CPAP compliance without the high costs of CPAP titration. However, no data are available on the effects of APAP on cardiovascular risk factors

Methods: We performed standard full polysomnography; obtained plasma levels of glucose, insulin, and C-reactive protein (CRP); and measured systolic BP (SBP) and diastolic BP (DBP) in 31 patients with newly diagnosed, severe OSA. After standard CPAP titration, all subjects were randomized to CPAP or APAP treatment. Measurements were obtained at baseline and after 3 months of treatment.

Results: The two groups were similar in terms of age, sex, body mass index (BMI), and severity of OSA. SBP, DBP, heart rate (HR), homeostasis model assessment index (HOMA-IR), and CRP were similar in the two groups. After 3 months of treatment, BMI, HR, and compliance to therapy were also comparable. OSA indexes were significantly reduced in both groups. Significant reductions in SBP, DBP, and HOMA-IR were observed in the CPAP group but not in the APAP group, while CRP plasma levels were similarly reduced.

Conclusions: Our results suggest that CPAP and APAP, despite significant effects on OSA indexes and symptoms, do not improve cardiovascular risk factors in the same fashion.

Key Words: BP • continuous positive airway pressure • inflammation • insulin resistance • obstructive sleep apnea

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