Sleep Disorders: Research Investigations in Obstructive Sleep Apnea |

Alternative Metabolic Parameters of Cardiovascular Risk in OSA Patients FREE TO VIEW

Sharon Hsieh, BS; Robert Havranek, BS; Mary-Margaret Ciavatta, PA-C; Tina Constantin, MD; Miriam Thomas, MD; John Miller, MD; Kandace McCarver, PA-C; Jeremy Anthony, MD; Mary Ellen Sweeney, MD; Octavian Ioachimescu, MD
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Emory University, VAMC Atlanta, Decatur, GA

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):1262A. doi:10.1016/j.chest.2016.08.1376
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SESSION TITLE: Research Investigations in Obstructive Sleep Apnea

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Wednesday, October 26, 2016 at 08:45 AM - 10:00 AM

PURPOSE: Complex interrelationships between metabolic parameters and obstructive sleep apnea (OSA) exist. OSA is often associated with obesity, hypertension, diabetes mellitus and dyslipidemia. Moderate or severe OSA is generally treated with continuous positive airway pressure (CPAP). In this study, we assessed several alternative metabolic parameters in patients with and without OSA, and the effects of CPAP therapy on these parameters.

METHODS: This point-of-care cohort consisted of 928 consecutive patients recruited from sleep clinics (87% men; 62% African-Americans) and evaluated longitudinally in the CPAP program for a median of 30 (25%-75% IQR of 18.5 to 52.5) months. In these patients, we calculated several alternative metabolic parameters such as: Lipid Accumulation Product (LAP), calculated as TG x (AC - 65) x 0.0113 in men and TG x (AC - 58) x 0.0113 in women [TG=triglyceride concentration, in mg/dL; AC=abdominal circumference, in cm); Central Obesity Index (COI), calculated as 100 x [AC (cm)/Height (cm)]; Weight (kg)/HDL (mg/dL) (a previously validated surrogate marker of insulin resistance). These parameters (LAP, COI, Weight/HDL-Cholesterol) have been studied before and found to be useful surrogate markers of cardiovascular risk, as they are associated with insulin resistance and glucose intolerance.

RESULTS: Obesity was found in 65% of the patients; diabetes mellitus in 28%; dyslipidemia in 52% of the cohort and hypertension in 63% of the subjects. OSA was present in 80% of patients. In subjects with and without OSA, mean LogLAP was 4.3 and 3.8, respectively (p<0.0001), while COI was 63.3 and 57.0, respectively (p<0.0001). Mean Weight/HDL was 2.23, 2.54, 2.80 and 3.16 in subjects without OSA, with mild, moderate and severe OSA, respectively (p<0.0001). Delta Weight/HDL-Cholesterol post - pre CPAP was -0.06 and 0.20 in patients without and with outstanding CPAP compliance, i.e., those with CPAP usage > 8 hours per night and > 90% of the nights, respectively [a difference of 0.27 (95% CI 0.03 -0.51, p=0.0265)].

CONCLUSIONS: In sleep clinic patients with OSA, several alternative metabolic parameters such as Lipid Accumulation Product (LAP), Central Obesity Index (COI) and Weight/HDL-Cholesterol have potential utility in stratifying cardiovascular risks.

CLINICAL IMPLICATIONS: Lipid Accumulation Product (LAP), Central Obesity Index (COI) and Weight/HDL-Cholesterol ratio are useful in stratifying cardiovascular risks in patients with OSA, as they correlate with insulin resistance and abnormal glucose metabolism.

DISCLOSURE: The following authors have nothing to disclose: Sharon Hsieh, Robert Havranek, Mary-Margaret Ciavatta, Tina Constantin, Miriam Thomas, John Miller, Kandace McCarver, Jeremy Anthony, Mary Ellen Sweeney, Octavian Ioachimescu

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