Oxidative stress and metabolic changes after continuous positive airway pressure treatment according to previous metabolic disorders in sleep apnea-hypopnea syndrome patients

doi:10.1016/j.trsl.2009.06.001

Translational Research

Volume 154, Issue 3, September 2009, Pages 111-121

https://doi.org/10.1016/j.trsl.2009.06.001 Get rights and content

Sleep apnea-hypopnea syndrome (SAHS) is characterized by recurrent episodes of hypoxia/reoxygenation, which seems to promote oxidative stress. SAHS patients experience increases in hypertension, obesity, and dyslipidemia, and the oxidative state has been related to the genesis of these disorders. The purpose of this study was to examine the changes in oxidative stress markers and metabolic parameters in S AHS patients after 1 month of treatment with continuous positive airway pressure (CPAP), in relation to their previous metabolic disorders. The study included 78 SAHS patients who required CPAP. The patients were classified according to their disorders, including hypertension, obesity, and dyslipidemia. Measurements were made before and after 1 month of treatment with CPAP. The diastolic blood pressure decreased after treatment in all the patients, significantly so in those who were nondyslipidemic, obese, or hypertensive (the systolic pressure also fell in these latter patients). Plasma oxidative stress biomarkers showed a significant antioxidant capacity and increased activity (P < 0.05) after treatment, more so in the nondyslipidemic and hypertensive patients. Furthermore, serum lipid peroxidation levels decreased after CPAP (P < 0.01). No change was observed in insulin resistance (IR) after CPAP treatment in any of the different disorders. In conclusion, oxidative stress markers improved significantly after CPAP treatment in SAHS patients, especially in the nondyslipidemic and hypertensive patients. Moreover, the blood pressure decreased after CPAP treatment, particularly in the obese, nondyslipidemic, and hypertensive patients. No significant change in IR was found in any of the SAHS patients after CPAP treatment.

Section snippets

Study subjects

The study included 78 patients with SAHS who required CPAP, according to established criteria.¹⁴ Diabetic patients who required insulin were excluded, as were patients who failed to complete 1 month of treatment or whose weight changed by more than 1.5 kg during the study.

The patients were classified as having hypertension or dyslipidemia according to Adult Treatment Panel III criteria. The patients were classified into 2 groups for blood pressure: hypertensive (n = 60) and normotensive (n = 18).

Results

The clinical variables of the patients are shown in Table I. The blood pressure decreased after treatment, although this was only significant for the diastolic blood pressure (84.50 ± 16.21 mmHg vs 80.96 ± 13.46 mmHg) (P < 0.05). The ESS also decreased significantly (15.29 ± 5.46 vs 9.52 ± 4.59, P < 0.05). The other clinical and biological variables experienced no significant changes. Evaluation of the plasma biomarkers of oxidative stress showed significant increases after CPAP treatment in catalase (2.55 ±

Discussion

The sleep apnea-hypopnea syndrome has been associated with metabolic abnormalities such as hypertension, insulin resistance, dyslipidemia, and low HDL cholesterol levels. However, the mechanisms underlying the increased prevalence of these disorders in SAHS patients remain poorly understood.

In our study, oxidative stress parameters showed an improvement after CPAP. SAHS severity has been correlated with oxidative stress levels in many studies.¹⁸ Our data show that a greater SAHS severity is

References (44)

Y.J. Suzuki et al.
Oxidative stress and oxidant signalling in obstructive sleep apnea and associated cardiovascular diseases
Free Radic Biol Med
(2006)
E.M. Conner et al.
Inflammation, free radicals, and antioxidants
Nutrition
(1996)
N. Peled et al.
The association of OSA with insulin resistance, inflammation and metabolic syndrome
Respir Med
(2007)
J.W. Eriksson
Metabolic stress in insulin's target cells leads to ROS accumulation—a hypothetical common pathway causing insulin resistance
FEBS Lett
(2007)
E. Chiner et al.
Validation of the Spanish version of the Epworth Sleepiness Scale in patients with a sleep apnea syndrome
Arch Bronconeumol
(1999)
M. Yamauchi et al.
Oxidative stress in obstructive sleep apnea
Chest
(2005)
A. Ghiselli et al.
Total antioxidant capacity as a tool to assess redox status: critical view and experimental data
Free Radic Biol Med
(2000)
K. Christou et al.
Nasal continuous positive airway pressure treatment reduces systemic oxidative stress in patients with severe obstructive sleep apnea syndrome
Sleep Med
(2009)
F. Cardona et al.
Similar increase in oxidative stress after fat overload in persons with baseline hypertriglyceridaemia with or without the metabolic syndrome
Clin Biochem
(2008)
K. Usui et al.
Inhibition of awake sympathetic nerve activity of heart failure patients with obstructive sleep apnea by nocturnal continuous positive airway pressure
J Am Coll Cardiol
(2005)

P.K. Singal et al.

Role of free radicals in catecholamine-induced cardiomyopathy

Can J Physiol Pharmacol

(1982)

G.E. Foster et al.

Intermittent hypoxia and vascular function: implications for obstructive sleep apnoea

Exp Physiol

(2007)

K. Narkiewicz et al.

Altered cardiovascular variability in obstructive sleep apnea

Circulation

(1998)

A.D. Dobrian et al.

Role of angiotensin II and free radicals in blood pressure regulation in a rat model of renal hypertension

Hypertension

(2001)

B. Brooks et al.

Obstructive sleep apnea in obese noninsulin-dependent diabetic patients: effect of continuous positive airway pressure treatment on insulin responsiveness

J Clin Endocrinol Metab

(1994)

M.S. Ip et al.

Obstructive sleep apnea is independently associated with insulin resistance

Am J Respir Crit Care Med

(2002)

R. Hertz et al.

Fatty acyl-CoA thioesters are ligands of hepatic nuclear factor-4

Nature

(1998)

M. Hirshkowitz et al.

Positive airway pressure therapy of OSA

Semin Respir Crit Care Med

(2005)

D. Carl et al.

Obstructive sleep apnea, hypertension, and wakefulness-promoting agents

Curr Hypertens Rep

(2007)

Consenso Nacional sobre el síndrome de apneas-hipopneas durante el sueño

Arch Bronconeumol

(2005)

International classification of sleep disorders. Diagnostic and coding manual

(2005)

D.R. Matthews et al.

Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man

Diabetologia

(1985)

Cited by (39)

Immune system and olive oil
2020, Olives and Olive Oil in Health and Disease Prevention
Dietary components, olive oil and its fractions, are capable to effect on immune network and their mechanisms. Olive oil is a principal source of dietary lipids and polyphenols in the Mediterranean diet, which is especially relevant in the case of extra-virgin olive oil (VOO) and also in VOO. They can effect cytokine production, signaling pathways, and overall health status. This chapter summarizes the key works of olive and olive oil fractions on immune system and several immune-mediated diseases.
Metabolic syndrome
2017, Medicine (Spain)
El síndrome metabólico se considera un método sencillo y fácil de aplicar en la práctica diaria, que ayuda a identificar una población con riesgo elevado de padecer ECV y DMT2 y a guiar la toma de decisiones clínicas. La evaluación debe incluir la medición de la presión arterial, la circunferencia de la cintura, el perfil de lípidos en ayunas (triglicéridos y colesterol HDL) y la glucosa en ayunas.
La evaluación del síndrome metabólico debe realizarse en todos los pacientes con sobrepeso u obesao y en aquellos que presenten algún factor de riesgo de diabetes o enfermedad cardiovascular como hipertensión, diabetes, dislipidemia o sedentarismo.
Se puede obtener el diagnóstico en cualquier consulta de Atención Primaria. Ofrece un mensaje de salud pública fácil de entender y recuerda a los profesionales de la salud que existe la necesidad de evaluar los demás factores de riesgo relacionados cuando se detecte uno de ellos.
Metabolic syndrome is considered a simple method that is easy to apply in daily practice, and which helps to identify populations at high risk of CVD and DMT2, as well as to guide clinical decision making. Assessment should include measurements of blood pressure, waist circumference, fasting lipid profile (triglycerides and HDL cholesterol), and fasting blood sugar.
All overweight and obese patients should be assessed for metabolic syndrome, and those presenting risk factors for diabetes or cardiovascular disease such as hypertension, diabetes, dyslipidaemia or physical inactivity.
A diagnosis can be made in any primary consultation. This offers an easily understandable public health message and reminds healthcare practitioners that when one risk factor is detected the patient must be assessed for other related risk factors.
Continuous positive airway pressure and diabetes risk in sleep apnea patients: A systemic review and meta-analysis
2017, European Journal of Internal Medicine
Citation Excerpt :
Analysis of publication bias by the Egger's test for the FBG findings found the one-tailed P-value to be significant (0.001), suggesting publication bias may confound these results (Fig. 3C). Thirteen studies were included for the analysis of fasting insulin [14,34,37,39,41,44–48,50,51,53]. No heterogeneity was observed among these studies (Q-value = 20.74, P = 0.054, I2 = 42.14%), thus a fixed effect model was used.
The study assessed the effect of continuous positive airway pressure (CPAP) therapy on the risk of developing type 2 diabetes by evaluating change in the homeostasis model assessment of insulin resistance (HOMA-IR) fasting blood glucose (FBG) and fasting insulin following CPAP treatment in non-diabetic patients and pre-diabetic with obstructive sleep apnea (OSA).
Medline, PubMed, Cochrane, and EMBASE databases were searched until August 24, 2015. The analysis included randomized controlled trials (RCTs), two arm prospective studies, cohort studies, and retrospective studies. The primary outcome measure was change of HOMA-IR in pre-diabetic patients receiving CPAP treatment.
Twenty-three studies were included with 965 patients who had OSA. Nineteen studies were prospective studies and four were RCTs. CPAP therapy resulted in a significant reduction in the pooled standard difference in means of HOMA-IR (− 0.442, P = 0.001) from baseline levels compared with the control group. Change in FBG and fasting insulin from baseline levels was similar for the CPAP and control groups. For RCT studies (n = 4), there was no difference in change in HOMA-IR or FBG levels from baseline between CPAP and control groups. The combined effect of RCTs showed that CPAP was associated with a significant reduction in change from baseline in fasting insulin than the control group (standardized diff. in means between groups = − 0.479, P value = 0.003).
These findings support the use of CPAP in non-diabetic and pre-diabetic patients with OSA to reduce change of HOMA-IR and possibly reduce the risk of developing type 2 diabetes in this patient population.
Effects of continuous positive airway pressure treatment on glucose metabolism in patients with obstructive sleep apnea
2016, Sleep Medicine Reviews
Citation Excerpt :
Although some studies detected a reduction in visceral adipose tissue and circulating leptin levels [35] or a reversion of hypoadiponectinemia [37], none detected a change in insulin resistance. Likewise, insulin resistance was also a secondary variable in observational studies with various sample sizes and follow-ups that showed a CPAP effect on the lipid profile [38], oxidative stress [39] or endothelial reactivity [40] of patients with OSA and different associated comorbidities. None of them identified a CPAP effect on insulin resistance.
A possible association between obstructive sleep apnea (OSA) and type 2 diabetes (T2DM) has been suggested. OSA could alter glucose metabolism, generating insulin resistance and favoring the development of T2DM. In addition, our greater understanding of intermediate disorders produced by intermittent hypoxia and sleep fragmentation, such as sympathetic activation, oxidative stress, systemic inflammation and alterations in appetite-regulating hormones, provides biological plausibility to this possible association. Nevertheless, there are still few data available about the consequences of suppressing apnea. Therefore, the objective of this review was to analyze current knowledge about the effect of continuous positive airway pressure (CPAP) on glucose metabolism.
A global interpretation of the studies evaluated shows that CPAP could improve insulin resistance, and perhaps also glycemic control, in OSA patients who still have not developed diabetes. In addition, it seems possible that the effect of CPAP is still greater in patients with OSA and T2DM, particularly in those patients with more severe and symptomatic OSA, in those with poorer baseline glycemic control and with greater compliance and duration of CPAP treatment.
In conclusion, although the current information available is limited, it suggests that apnea reversion by means of CPAP could improve the control of glucose metabolism.
Oxidative Stress in Sleep Apnea
2015, Modulation of Sleep by Obesity, Diabetes, Age, and Diet
Sleep apnea syndrome (SAS) is a widespread sleeping disorder with severe cardiovascular complications including hypertension, atherosclerosis, and ischemic heart disease. Although several mechanisms are involved in the pathogenesis of these complications, oxidative stress plays an important role. Numerous studies showed increased oxidative damage in patients with SAS. The current gold standard of treatment—continuous positive airway pressure (CPAP)—reduces systemic and local oxidative stress. The chapter gives an overview of the current knowledge regarding oxidative stress in SAS and explains the mechanism of hypoxia–reoxygenation as an underlying process that generates oxidative stress. Future research should prove whether targeted antioxidant treatment has therapeutic potential, especially in patients nonadherent to CPAP.
The Mediterranean Diet and Obstructive Sleep Apnoea/Hypopnoea Syndrome
2015, The Mediterranean Diet: An Evidence-Based Approach
Obstructive sleep apnoea/hypopnoea syndrome (OSAHS), a chronic condition characterized by an obstruction of the upper airway during sleep, is an increasingly cause of morbidity and mortality. Obesity is considered to be the most important risk factor for OSAHS. It has been estimated that a high percentage of patients with OSAHS are suffering from obesity, and that weight reduction is a very effective modality in these patients. Research has highlighted the beneficial role of the Mediterranean diet in weight loss and obesity-related complications. This chapter of OSAHS management addresses current data from the perspective of levels of evidence for the role of the Mediterranean diet in OSAHS.

View all citing articles on Scopus

: Supported in part by grants from the Andalusian Health Service (SAS PI-0326/2007) and grants from the Spanish Ministry of Education and Science (SAF2006-12984), a predoctoral Investigator Personal Formation grant (BES-2007-16594) from the Spanish Ministry of Science and Innovation (MICINN), and a CP07/0095 grant (to F.C.).

View full text

Original articleOxidative stress and metabolic changes after continuous positive airway pressure treatment according to previous metabolic disorders in sleep apnea-hypopnea syndrome patients

Section snippets

Study subjects

Results

Discussion

Free Radic Biol Med

Nutrition

Respir Med

FEBS Lett

Arch Bronconeumol

Chest

Free Radic Biol Med

Sleep Med

Clin Biochem

J Am Coll Cardiol

Role of free radicals in catecholamine-induced cardiomyopathy

Can J Physiol Pharmacol

Intermittent hypoxia and vascular function: implications for obstructive sleep apnoea

Exp Physiol

Altered cardiovascular variability in obstructive sleep apnea

Circulation

Role of angiotensin II and free radicals in blood pressure regulation in a rat model of renal hypertension

Hypertension

Obstructive sleep apnea in obese noninsulin-dependent diabetic patients: effect of continuous positive airway pressure treatment on insulin responsiveness

J Clin Endocrinol Metab

Obstructive sleep apnea is independently associated with insulin resistance

Am J Respir Crit Care Med

Fatty acyl-CoA thioesters are ligands of hepatic nuclear factor-4

Nature

Positive airway pressure therapy of OSA

Semin Respir Crit Care Med

Obstructive sleep apnea, hypertension, and wakefulness-promoting agents

Curr Hypertens Rep

Consenso Nacional sobre el síndrome de apneas-hipopneas durante el sueño

Arch Bronconeumol

International classification of sleep disorders. Diagnostic and coding manual

Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man

Diabetologia

Original article
Oxidative stress and metabolic changes after continuous positive airway pressure treatment according to previous metabolic disorders in sleep apnea-hypopnea syndrome patients