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Original Research: Sleep Disorders |

CPAP Improves Endothelial Function in Patients With Minimally Symptomatic OSAEndothelial Function in Minimally Symptomatic OSA: Results From a Subset Study of the MOSAIC Trial

Malcolm Kohler, MD; Sonya Craig; Justin C. T. Pepperell, MD; Debby Nicoll, PhD; Daniel J. Bratton, MSc; Andrew J. Nunn, MSc; Paul Leeson, PhD; John R. Stradling, MD
Author and Funding Information

From the Sleep Unit and Pulmonary Division (Prof Kohler), University Hospital Zurich, Zurich, Switzerland; the Oxford Centre for Respiratory Medicine and Oxford Biomedical Research Centre (Prof Kohler, Drs Nicoll and Stradling, and Ms Craig), Churchill Hospital, Oxford, England; the Somerset Centre for Respiratory Medicine (Dr Pepperell), Musgrove Park Hospital, Taunton, England; the Clinical Trials Unit (Messrs Bratton and Nunn), Medical Research Council, London, England; and the Department of Cardiovascular Medicine (Dr Leeson), John Radcliffe Hospital, Oxford, England.

Correspondence to: Malcolm Kohler, MD, Sleep Disorders Centre and Pulmonary Division, University Hospital of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland; e-mail: Malcolm.K@bluewin.ch


Funding/Support: This study was supported by an unrestricted project grant from The British Heart Foundation; research salaries were paid for by Oxford Health Services Research Committee; an unrestricted charitable donation was made by ResMed UK to support research work in the Oxford Sleep Unit in 1998 and 2006; and ResMed UK supplied the CPAP machines for this trial. Prof Kohler was a recipient of a European Respiratory Society [No. 118] and University of Zurich research fellowship.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;144(3):896-902. doi:10.1378/chest.13-0179
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Background:  Minimally symptomatic OSA is a highly prevalent disorder, and the effects of CPAP on vascular function in these patients are unknown. This trial aimed to investigate whether CPAP improves vascular function in minimally symptomatic OSA.

Methods:  In two centers taking part in the MOSAIC (Multicentre Obstructive Sleep Apnoea Interventional Cardiovascular) trial, 253 patients with minimally symptomatic OSA were randomized to 6 months of CPAP or standard care. Two hundred eight patients attended their follow-up visit within the predefined time window and had complete measurements of arterial stiffness (augmentation index [AIx]), and 64 patients had endothelial function measurements by brachial artery flow-mediated dilatation (FMD). Multivariable analyses adjusting for baseline measurements and minimization factors were performed to assess the effect of CPAP treatment on FMD (% dilatation) and AIx (% augmentation) compared with standard care.

Results:  The mean ± SD baseline oxygen desaturation index and Epworth Sleepiness Score (ESS) of the 208 patients (age 58 ± 7.3 years, 31 women) were 13.7 ± 12.8 events/h and 8.3 ± 4.2, respectively. There was no CPAP treatment effect on arterial stiffness (AIx, −1.4%; 95% CI, −3.6 to +0.9%; P = .23), but CPAP improved endothelial function (FMD, +2.1%; 95% CI, +1.0 to +3.2%; P < .0001). CPAP reduced daytime sleepiness (ESS, −2.2; 95% CI, −3.0 to −1.5; P < .0001) compared with standard care. There was a larger improvement in FMD in patients using CPAP for > 4 h/night than those who used it less (P = .013).

Conclusions:  CPAP improves endothelial function, but not arterial stiffness, in minimally symptomatic OSA. Thus, minimally symptomatic OSA may be a cardiovascular risk factor.

Trial registry:  ISRCTN Register; No.: ISRCTN 34164388; URL: http://isrctn.org

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