SESSION TITLE: Aftermath of OSA and Its Treatment
SESSION TYPE: Original Investigation Slide
PRESENTED ON: Tuesday, October 27, 2015 at 08:45 AM - 10:00 AM
PURPOSE: Complex interrelationships between cardio-metabolic parameters and obstructive sleep apnea (OSA) exist. Significant OSA is generally treated with continuous positive airway pressure (CPAP). We aimed to assess in this study the effects of CPAP therapy on the glucose and lipid metabolism in patients with OSA.
METHODS: We followed a cohort of 925 consecutive veteran patients seen in sleep clinics (86% men; 61% African-Americans). Comorbidities, cardio-metabolic risk factors, anthropometric measurements, presence of OSA, CPAP therapy and therapeutic adherence were recorded. Markers of glucose and lipid metabolism were assessed before and after CPAP therapy. Our hypothesis was that better adherence to CPAP therapy translates into better cardio-metabolic profiles.
RESULTS: Median (25th, 75th IQR) body mass index was 31.8 (28.4, 36.7) kg/m2. OSA was diagnosed in 737 subjects (80%). Mild, moderate and severe OSA was found in 52%, 30% and 18%, respectively. 717 patients (77.5%) were on CPAP therapy and were followed for a median (IQR) of 5 (3, 14) months. At follow-up, median (IQR) CPAP usage was 32% (4%, 78%) of the nights, with 4.7 (2.6, 6.3) hours nightly. At follow-up, mean weight gain was +0.45 kg; in diabetics, mean weight change was negative (-0.2 kg), while those without diabetes mellitus had a mean weight gain of 0.7 kg (p=0.03). This had a significant impact on the follow-up lipid and glycemic parameters. As such, follow-up HbA1c was 6.75%, up from 6.57% (p=0.0001). This was driven mainly by weight gain, especially in non-diabetics. The slope of hemoglobin A1c values after vs. before CPAP therapy was significantly flatter in patients with better therapeutic adherence. Patients in the 1st quartile (<2.6 hours) vs. in the 4th quartile (>6.3 hours) of CPAP use time had statistically higher HbA1c (6.94% vs. 6.51%, respectively, p=0.04).
CONCLUSIONS: In sleep clinic patients, we found that cardio-metabolic parameters were influenced mainly by weight gain and CPAP therapy, despite relatively short follow-up. Better adherence to CPAP therapy led to better cardio-metabolic profiles.
CLINICAL IMPLICATIONS: Short-term cardio-metabolic effects of CPAP therapy are variable and largely influenced by weight gain, medication changes and therapeutic adherence. The beneficial metabolic effects of CPAP are positively correlated with the therapeutic adherence.
DISCLOSURE: The following authors have nothing to disclose: Jeremy Anthony, Mary-Margaret Ciavatta, Tina Constantin, Kandace McCarver, Mary-Ellen Sweeney, Octavian Ioachimescu
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