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Original Research: SLEEP MEDICINE |

Appropriate Use of Nasal Continuous Positive Airway Pressure Decreases Elevated C-Reactive Protein in Patients With Obstructive Sleep Apnea

Katsunori Ishida, MD; Masahiko Kato, MD, PhD; Yosuke Kato, MS; Kiyotaka Yanagihara, MD, PhD; Yoshiharu Kinugasa, MD, PhD; Kazuhiko Kotani, MD, PhD; Osamu Igawa, MD, PhD; Ichiro Hisatome, MD, PhD; Chiaki Shigemasa, MD, PhD; Virend K. Somers, MD, PhD, FCCP
Author and Funding Information

From the Department of Cardiovascular Medicine (Drs. Ishida, M. Kato, Yanagihara, Kinugasa, Igawa, and Shigemasa, and Mr. Y. Kato), and the Department of Genetic Medicine and Regenerative Therapeutics (Dr. Hisatome), Graduate School of Medical Science, Tottori University, Yonago, Japan; the Department of Clinical Laboratory Medicine (Dr. Kotani), Jichi Medical University, Tochigi, Japan; and the Division of Cardiovascular Disease (Dr. Somers), Mayo Clinic, Rochester, MN.

Correspondence to: Masahiko Kato, MD, PhD, Department of Cardiovascular Medicine, Tottori University, 36-1 Nishimachi Yonago, Japan; e-mail: mkato@grape.med.tottori-u.ac.jp


This research was supported by National Institutes of Health grants HL65176, HL 73211, and RR00585 (to Dr. Somers).

Dr. Somers has served as a consultant for ResMed, Respironics, Medtronic, GlaxoSmithKline, Sepracor, and Cardiac Concepts. He has received research grants from the ResMed Foundation, the Respironics Sleep and Breathing Foundation, ELA Medical, and Select Research, Inc. Drs. Ishida, M. Kato, Yanagihara, Kinugasa, Kotani, Igawa, Hisatome, and Shigemasa, and Mr. Y. Kato have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).


© 2009 American College of Chest Physicians


Chest. 2009;136(1):125-129. doi:10.1378/chest.08-1431
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Background:  C-reactive protein (CRP) is an important risk factor for cardiovascular disease. Furthermore, it has been reported that levels of CRP are increased in patients with obstructive sleep apnea (OSA). The aim of this study was to examine the effects of long-term therapy with nasal continuous positive airway pressure (nCPAP) on CRP levels and to investigate whether compliance with nCPAP therapy more effectively attenuated markers of systemic inflammation in patients with OSA.

Methods and results:  Fifty-five patients (mean [± SEM] age, 55 ± 2 years; 44 male patients, 11 female patients) with newly diagnosed moderate-to-severe OSA (apnea-hypopnea index > 20 events/h) were studied before and after 6 months of nCPAP treatment. There was a significant reduction in CRP levels after nCPAP therapy (before nCPAP therapy, 0.23 ± 0.03 mg/dL; after nCPAP therapy, 0.17 ± 0.02 mg/dL; p < 0.01). Additionally, we divided these patients into two groups based on adherence to nCPAP therapy. A group of patients using nCPAP > 4 h/d and > 5 d/wk were designated as the good compliance group. The decrease in CRP concentration was significant (before nCPAP therapy, 0.23 ± 0.04 mg/dL; after nCPAP therapy, 0.16 ± 0.03 mg/dL; p < 0.05) in the good compliance group but not in the poor compliance group (before nCPAP therapy, 0.24 ± 0.05 mg/dL; after nCPAP therapy, 0.20 ± 0.05 mg/dL; p = 0.21). Furthermore, we divided those patients into a high CRP group (≥ 0.2 mg/dL) and a normal CRP group (< 0.2 mg/dL) before nCPAP therapy. The significant decrease in CRP levels in the good compliance group was evident only in those patients with an initially elevated CRP level (before nCPAP therapy, 0.48 ± 0.08 mg/dL; after nCPAP therapy, 0.29 ± 0.06 mg/dL; p < 0.05).

Conclusion:  Appropriate use of nCPAP in patients with OSA may be required to decrease elevated CRP levels, with possible implications for cardiovascular morbidity and mortality.

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