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Circulating cardiovascular risk factors in obstructive sleep apnoea: data from randomised controlled trials
G V Robinson1, J C T Pepperell, H C Segal
1Oxford Centre for Respiratory Medicine, Churchill Hospital Site, Oxford Radcliffe Hospitals, Oxford OX3 7LJ, UK. gracevrobinson@yahoo.co.uk
Thorax
|August 31, 2004
Summary
Obstructive sleep apnoea (OSA) is linked to increased cardiovascular risk markers. While continuous positive airway pressure (CPAP) treatment did not lower coagulation factors, it significantly reduced total cholesterol, potentially lowering cardiovascular risk.
Area of Science:
- Cardiovascular Medicine
- Sleep Medicine
- Hematology
Background:
- Obstructive sleep apnoea (OSA) is a significant independent risk factor for hypertension and is associated with elevated cardiovascular morbidity and mortality.
- Novel circulating cardiovascular risk markers are crucial for accurate risk prediction in OSA patients.
- Investigating these markers can elucidate the heightened cardiovascular risk in OSA and assess treatment benefits.
Purpose of the Study:
- To evaluate the impact of continuous positive airway pressure (CPAP) treatment on specific cardiovascular risk markers in patients with OSA.
- To determine if CPAP therapy influences activated coagulation factors and lipid profiles in OSA patients.
Main Methods:
- Plasma levels of total cholesterol, triglyceride, activated coagulation factors (XIIa, VIIa), and other markers (TAT, vWFAg, sP-sel, homocysteine) were measured.
- 220 OSA patients were treated for 1 month with either therapeutic or subtherapeutic (control) CPAP.
- Pre- and post-treatment levels were compared to assess treatment effects.
Main Results:
- Elevated levels of activated coagulation factors XIIa, VIIa, TAT, and sP-sel were observed in OSA patients at baseline.
- These coagulation factors did not decrease after 1 month of therapeutic CPAP treatment.
- Therapeutic CPAP resulted in a clinically significant mean reduction in total cholesterol (0.28 mmol/l), potentially reducing cardiovascular risk by approximately 15%.
Conclusions:
- Increased activated coagulation factors in untreated OSA may contribute to vascular risk, but are not affected by 1 month of CPAP.
- Nasal CPAP therapy shows potential for a clinically relevant reduction in total cholesterol levels.
- Further large-scale prospective studies are needed to validate the cardiovascular risk reduction associated with CPAP-induced cholesterol changes in OSA.