Continuous positive airway pressure (CPAP) therapy for 6 months offers patients with obstructive sleep apnea (OSA) a greater chance of reversing metabolic syndrome compared with patients with OSA not treated with CPAP, according to findings presented virtually at the American Thoracic Society (ATS) 2020 Virtual meeting, held from August 5 to 10, 2020.
Researchers conducted a placebo-controlled trial (TREATOSA-MS; ClinicalTrials.gov Identifier: NCT02295202) that included patients with a confirmed diagnosis of metabolic syndrome and moderate to severe OSA (age, 48±9 years; body mass index [BMI], 33±4 kg/m2; apnea hypopnea index, 59±29 events/h). None of the patients included in the sample were smokers or used medications. Patients were randomly assigned to undergo either therapeutic CPAP (n=50) or nasal strips (ie, placebo; n=50) for a 6-month period.
Measurements of anthropometric variables, blood pressure, fasting blood glucose levels, lipid profile, body composition by bioimpedance, physical activity, food intake, and visceral fat were obtained before and after each intervention. The rate of metabolic syndrome reversibility was the primary end point.
The mean adherence to therapeutic CPAP was 5.7±1.5 hours per night. Patients in the CPAP group experienced significant improvements in OSA severity, hypoxemic parameters, and daytime somnolence during the 6-month period. Treatment with CPAP for 6 months was associated with a significantly greater rate of metabolic syndrome reversibility compared with nasal strips (18% vs 4%, respectively; odds ratio, 5.27; 95% CI, 1.27-35.86; P =.04).
From baseline to 6 months, the mean number of metabolic syndrome components were 3.7±0.6 vs 3.8±0.8 in the placebo and 3.7±0.6 vs 3.2±0.9 in CPAP groups, respectively (mean difference, 0.02±0.80 and -0.42±0.95, respectively; P =.01). According to the investigators, this difference was likely a result of improvements in blood pressure.
Treatment with CPAP for 6 months was associated with significant reductions in systolic blood pressure (-7±12 mm Hg vs -2±11 mm Hg; P =.03) and diastolic blood pressure (-5±8 mm Hg vs -1±8 mm Hg; P =.01) vs placebo. In both groups, there were no significant changes in BMI, food intake, physical activity, body composition, or visceral fat.
The researchers concluded that CPAP therapy was able to promote a 5-fold increased chance of reversing metabolic syndrome in patients with OSA and metabolic syndrome, and that the effect could not be explained by changes in weight, adiposity, physical activity, or food intake.
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Giampá SQ, Freitas LS, Furlan SF, et al. Effects of CPAP on metabolic syndrome in patients with obstructive sleep apnea: the TREATOSA-MS randomized controlled trial. Presented at: American Thoracic Society 2020 Virtual; August 5-10, 2020. Abstract #822.