Differences of Short-Term Systemic Responses in Obstructive Sleep Apnea Patient by Compliance of Continuous Positive Airway Pressure

Jong In Jeong; Su Jin Kim; Sang Duk Hong; Seung Kyu Chung; Hun-Jong Dhong; Hyo Yeol Kim

doi:10.18787/jr.2015.22.2.75

Journal List > J Rhinol > v.22(2) > 1044347

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Jeong, Kim, Hong, Chung, Dhong, and Kim: Differences of Short-Term Systemic Responses in Obstructive Sleep Apnea Patient by Compliance of Continuous Positive Airway Pressure

Original Article

J Rhinol 2015;22(2):75-81.

Published online: 10 January 2015

DOI: https://doi.org/10.18787/jr.2015.22.2.75

Differences of Short-Term Systemic Responses in Obstructive Sleep Apnea Patient by Compliance of Continuous Positive Airway Pressure

Jong In Jeong, MD, Su Jin Kim, MD, Sang Duk Hong, MD, Seung Kyu Chung, MD, Hun-Jong Dhong, MD, Hyo Yeol Kim, MD

Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

교신저자：김효열, 06351 서울 강남구 일원로 81 성균관대학교 의과대학 삼성서울병원 이비인후과학교실 Tel: +82-2-3410-1785, Fax: +82-2-3410-3879, E-mail: siamkhy@gmail.com

Received 11 May 2015 Revised 19 June 2015 Accepted 29 July 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

Obstructive sleep apnea (OSA) is characterized by repeated apnea, hypopnea, and micro-arousals during sleep. Many studies have described correlations between OSA and multiple systemic diseases, such as cardiovascular, cerebrovascular, and metabolic diseases. The aim of this study was to determine whether the compliance of continuous positive airway pressure (CPAP) affects the short-term systemic responses in OSA patients.

Methods

Twenty-four newly diagnosed OSA patients were enrolled. All subjects used CPAP for 4 weeks. The subjects were divided into two groups according to the rate of using CPAP over 4 hours per night. Complete blood cell count, coagulation results, blood chemistry, lipid profiles, and pulmonary function results were evaluated at baseline, and were followed up after 4 weeks.

Results

After CPAP treatment, WBC count, hemoglobin, hematocrit, albumin, AST, ALT, Cl, and peak expiratory flow rate (PEFR) were significantly changed in the higher compliance group (n=14), whereas platelet count and triglyceride levels were significantly changed in the lower compliance group (n=10). In multivariate analysis, the changes in WBC count, hemoglobin and hematocrit were statistically significant between the higher compliance and lower compliance groups (p=0.0056, 0.0016, and 0.0051).

Conclusion

The compliance of CPAP affects the short-term systemic responses in OSA patient.

Keywords: OSA, CPAP, Intermittent hypoxia, Oxidative stress, Compliance of CPAP.

References

1). Chung YS. Pathogenesis of Obstructive Sleep Apnea. J Rhinol. 2009; 16:87–90.

2). Kim J, In K, Kim J, You S, Kang K, Shim J, et al. Prevalence of sleep-disordered breathing in middle-aged Korean men and women. Am J Respir Crit Care Med. 2004; 170:1108–13.

3). Mo JH. Obstructive Sleep Apnea and Systemic Diseases. J Rhinol. 2013; 20:8–12.

4). Jullian-Desayes I, Joyeux-Faure M, Tamisier R, Launois S, Borel AL, Levy P, et al. Impact of obstructive sleep apnea treatment by continuous positive airway pressure on cardiometabolic biomarkers: a systematic review from sham CPAP randomized controlled trials. Sleep Med Rev. 2015; 21:23–38.

5). Unnikrishnan D, Jun J, Polotsky V. Inflammation in sleep apnea: an update. Rev Endocr Metab Disord. 2015; 16:25–34.

6). Kohler M, Pepperell JC, Davies RJ, Stradling JR. Continuous positive airway pressure and liver enzymes in obstructive sleep apnoea: data from a randomized controlled trial. Respiration. 2009; 78:141–6.

7). Guilleminault C, Abad VC. Obstructive sleep apnea syndromes. Med Clin North Am. 2004; 88:611–30. viii.

8). Weaver TE, Maislin G, Dinges DF, Bloxham T, George CF, Greenberg H, et al. Relationship between hours of CPAP use and achieving normal levels of sleepiness and daily functioning. Sleep. 2007; 30:711–9.

9). Steiropoulos P, Kotsianidis I, Nena E, Tsara V, Gounari E, Hatzizi-si O, et al. Long-term effect of continuous positive airway pressure therapy on inflammation markers of patients with obstructive sleep apnea syndrome. Sleep. 2009; 32:537–43.

10). Chin K, Nakamura T, Takahashi K, Sumi K, Ogawa Y, Masuzaki H, et al. Effects of obstructive sleep apnea syndrome on serum aminotransferase levels in obese patients. Am J Med. 2003; 114:370–6.

11). Norman D, Bardwell WA, Arosemena F, Nelesen R, Mills PJ, Lore-do JS, et al. Serum aminotransferase levels are associated with markers of hypoxia in patients with obstructive sleep apnea. Sleep. 2008; 31:121–6.

12). Lin MT, Lin HH, Lee PL, Weng PH, Lee CC, Lai TC, et al. Beneficial effect of continuous positive airway pressure on lipid profiles in obstructive sleep apnea: a metaanalysis. Sleep Breath. 2015; 19:809–17.

13). Dewan NA, Nieto FJ, Somers VK. Intermittent hypoxemia and OSA: implications for comorbidities. Chest. 2015; 147:266–74.

14). Karamanlı H1. Özol D, Ugur KS, Yıldırım Z, Armutçu F, Bozkurt B, et al. Influence of CPAP treatment on airway and systemic inflammation in OSAS patients. Sleep Breath. 2014; 18:251–6.

15). Sökücü SN, Ozdemir C, Dalar L, Karasulu L, Aydın S, Altın S. Complete blood count alterations after six months of continuous positive airway pressure treatment in patients with severe obstructive sleep apnea. J Clin Sleep Med. 2014; 10:873–8.

16). Umlauf MG, Chasens ER. Sleep disordered breathing and nocturnal polyuria: nocturia and enuresis. Sleep Med Rev. 2003; 7:403–11.

17). Varol E, Ozturk O, Yucel H, Gonca T, Has M, Dogan A, et al. The effects of continuous positive airway pressure therapy on mean platelet volume in patients with obstructive sleep apnea. Platelets. 2011; 22:552–6.

18). Robinson GV, Pepperell JC, Segal HC, Davies RJ, Stradling JR. Circulating cardiovascular risk factors in obstructive sleep apnoea: data from randomised controlled trials. Thorax. 2004; 59:777–82.

19). Phillips CL, Yee BJ, Marshall NS, Liu PY, Sullivan DR, Grunstein RR. Continuous positive airway pressure reduces postprandial lipidemia in obstructive sleep apnea: a randomized, placebo-controlled crossover trial. Am J Respir Crit Care Med. 2011; 184:355–61.

20). Schlatzer C, Schwarz EI, Kohler M. The effect of continuous positive airway pressure on metabolic variables in patients with obstructive sleep apnoea. Chron Respir Dis. 2014; 11:41–52.

Table 1.

Baseline characteristics of higher compliance group and lower compliance group

Variable	Total (n=24)	Lower compliance group (n=10)	Higher compliance group (n=14)	p-value
Age (years)	48.5±12.6	48.0±16.5	48.8±9.5	0.8839
Male: Female	21: 3	9: 1	12: 2	1.0000
BMI	26.9±3.40	26.6±2.90	27.0±3.80	0.8836
Waist circumference (cm)	94.4±7.50	92.5±6.20	95.7±8.30	0.5003
Neck circumference (cm)
At supine	41.2±3.30	40.2±2.60	42.0±3.60	0.1926
At sitting	39.7±3.00	39.0±2.40	40.2±3.30	0.3245
AHI	52.4±23.9	36.3±16.7	63.9±21.9	0.0077^*

^* p＜0.05. BMI: body mass index (kg/m²), AHI: apnea-hypopnea index (/hr)

Table 2.

The changes of complete blood cell count and coagulation test after 4 weeks CPAP treatment

Variable	Lower compliance group			Higher compliance group
Variable	Baseline	After	p-value	Baseline	After	p-value
Complete blood cell count
WBC	006.8±1.9	006.7±2.1	0.7879	008.0±1.7	007.0±1.4	0.0038
RBC	004.9±0.5	004.9±0.5	0.8566	004.9±0.5	004.8±0.5	0.1285
Hb	015.0±1.4	015.1±1.5	0.8227	015.4±1.2	014.8±1.1	0.0006
Hct	043.7±3.2	044.1±4.0	0.2611	044.8±2.8	043.9±2.4	0.0381
Plt	219.2±33.1	205.9±32.1	0.0046	232.9±66.7	245.0±54.2	0.8000
Coagulation test
PT	013.1±0.6	013.0±0.6	0.2402	012.6±0.7	012.6±0.5	0.7579
INR	001.0±0.1	001.0±0.1	0.2602	001.0±0.1	000.9±0.1	0.7904
aPTT	035.8±3.2	034.7±3.5	0.3663	037.6±5.1	037.2±5.4	0.3547

WBC: white blood cell (×10³/μ L), RBC: red blood cell (×100³/μ L), Hb: hemoglobin (g/dl), Hct: hematocrit (%), Plt: platelet (×10³/μ L), PT: prothrombin time (sec), INR: international normalized ratio of PT, aPTT: activeted partial thromboplastin time (sec)

Table 3.

The changes of blood chemistry and lipid profile after 4 weeks CPAP treatment

Variable	Lower compliance group			Higher compliance group
Variable	Baseline	After	p-value	Baseline	After	p-value
Blood chemistry
Alb	004.6±0.2	004.5±0.2	0.3809	004.6±0.3	004.5±0.3	0.0218^*
AST	024.9±12.9	023.2±8.0	0.3923	029.5±8.4	024.7±8.5	0.0084^*
ALT	028.0±17.5	025.6±16.7	0.2610	043.8±21.9	033.1±19.5	0.0027^*
FBS	098.6±11.2	105.7±15.7	0.2028	105.0±20.9	105.0±9.3	1.0000
BUN	015.1±5.4	014.3±4.9	0.2727	015.9±3.9	013.8±2.9	0.1332
Cr	000.9±0.1	001.0±0.2	0.7109	000.9±0.2	000.9±0.1	0.9069
Na	140.7±1.6	140.7±2.4	0.8633	139.8±1.4	141.0±2.1	0.1085
K	004.3±0.4	004.3±0.4	0.5120	004.3±0.3	004.3±0.3	0.3928
Cl	103.0±1.1	103.0±1.7	1.0000	101.8±1.8	103.4±2.1	0.0124^*
Lipid profile
T-Chol	188.3±33.4	181.6±44.5	0.4231	198.9±43.2	192.7±32.6	0.2526
TG	193.2±154.4	233.6±163.1	0.0306^*	204.8±117.5	199.6±70.8	0.8435
HDL-C	048.8±16.6	045.1±10.6	0.6563	049.4±11.4	047.7±11.8	0.1003
LDL-C	120.8±34.6	111.8±40.1	0.1043	126.7±39.2	121.7±34.1	0.3654

^* p＜0.05. Alb: albumin (g/dL), AST: aspartate transaminase (IU/L), ALT: alanine transaminase (IU/L), FBS: fasting blood sugar (mg/ dL), BUN: blood urea nitrogen (mg/dL), Cr: creatinine (mg/dL), Na: sodium (mmol/L), K: potassium (mmol/L), Cl: chloride (mmol/L), T-Chol: total cholesterol (mg/dlL, TG: triglyceride (mg/dL), HDL-C: high density lipoprotein cholesterol (mg/dL), LDL-C: low density lipoprotein cholesterol (mg/dL)

Table 4.

Univariable analysis of the significantly changed parameters after 4 weeks CPAP treatment with t-test and Wilcoxon rank sum test

Variable	Lower compliance group	Higher compliance group	p-value
ΔWBC	–0.1±1.60	–1.0±1.10	0.1258
ΔHb	0.0±0.30	–0.6±0.50	0.0019^*
ΔHct	0.5±1.20	–1.0±1.60	0.0251^*
ΔPlt	–13.3±11.3	12.1±52.7	0.1497
ΔAlb	–0.1±0.20	–0.1±0.10	0.5578
ΔAST	–1.7±6.00	–4.8±5.80	0.2164
ΔALT	–2.4±6.30	–10.6±10.8	0.0418^*
ΔCl	0.0±1.70	1.6±2.00	0.0583
ΔTG	40.4±49.9	–5.2±96.9	0.1876
ΔPEFR	0.3±1.30	–1.1±1.80	0.0570

^* p＜0.05. Δ: change of parameter (after-baseline), PEFR: peak expiratory flow rate (l/sec)

Table 5.

Multivariable analysis of the significantly changed parameters after 4 weeks CPAP treatment with multiple linear regression analysis and multiple median regression analysis

Variable	Regression coefficient	Standard error	t-statics	p-value
Age, sex, baseline AHI, and baseline BMI adjusted model
Compliance group
ΔWBC	–1.85	0.59	–3.14	0.0056^*
ΔHb	–0.75	0.20	–3.72	0.0016^*
ΔHct	–2.29	0.72	–3.18	0.0051^*
ΔPlt	2.72	17.28	0.16	0.8767
ΔAlb	–0.07	0.07	–0.99	0.3354
ΔAST	–1.48	3.14	–0.47	0.6431
ΔALT	–7.13	5.04	–1.41	0.1743
ΔCl	1.66	1.06	1.56	0.1359
ΔTG	–56.30	56.72	–0.99	0.3341
ΔPEFR	–2.04	1.35	–1.51	0.1476

^* p＜0.05

TOOLS

Similar articles