Effect of Continuous Positive Airway Pressure on Cardiovascular Biomarkers: the Sleep Apnea Stress Randomized Controlled Trial

Background

Although existing research highlights the relationship of obstructive sleep apnea (OSA) and cardiovascular disease, the effect of OSA treatment on cardiovascular biomarkers remains unclear. We evaluated the effect of OSA treatment on oxidative stress/inflammation measures.

Methods

We conducted a parallel, randomized controlled trial in moderate to severe OSA (Apnea-Hypopnea Index>15) patients to examine effects of 2-month continuous positive airway pressure (CPAP) versus sham-CPAP on the primary outcome of oxidative stress/inflammation (F2-isoprostanes:ng/mg) and myeloperoxidase:pmol/L)) and secondary oxidative stress measures. Exploratory secondary analyses included vascular and systemic inflammation markers. Linear models adjusted for baseline values examined effect of CPAP on biomarker change (least squares means, 95%CI) including secondary stratified analyses examining CPAP adherence and degree of hypoxia.

Results

Of 153 participants, 76 were randomized to CPAP and 77 to sham-CPAP. In intent to treat analyses, no significant change was observed in the sham and CPAP groups respectively: F2-isoprostanes (-0.05, -0.15-0.06 versus -0.13, -0.23- -0.02) or myeloperoxidase (-3.33, -17.02-10.37 versus -5.15, -18.65-8.35), nor other oxidative markers; findings which persisted in analyses stratified by adherence and hypoxia. Exploratory analyses revealed percentage reduction of soluble IL-6 receptor (ng/ml) levels (-0.04, -0.08- -0.01 versus 0.02, -0.02-0.06, p=0.019) and augmentation index (%) (-6.49, -9.32, -3.65 versus 0.44, -2.22, 3.10, pConclusions

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