Thursday, December 15, 2011

CPAP Makes You Thinner?

What is metabolic syndrome?
It depends (only slightly) on who you ask.
In this study, they followed the criteria created by the National Cholesterol Education Program which is the following:
-- A large waist: A man's waist larger around than 40 inches (102 cm) or a woman's waist later around than 35 inches (88cm).
--Triglycerides greater than 150 mg/dl or needing a medication to treat high cholesterol
--Decreased good cholesterol (HDL) less than 40mg/dl if you're a man and less than 50mg/dl if you're a woman or, again, needing some medication to bring it up.
--High blood pressure greater than 130 systolic (top number) over 85 diastolic (bottom number), or needing a medication to treat a history of high blood pressure.
--High blood sugar greater than 100mg/dl while fasting or needing a medication to treat high sugar

Who cares if I have metabolic syndrome?
You should.
You're much more likely to die from a stroke or heart attack, or be severely crippled by either, if you have it and don't try to do something about it.

Summary of the study:
--They took 86 patients (final number) who had metabolic syndrome as defined above AND who also had sleep apnea.
--Their apnea was anything greater than 5 respiratory events per hour (choking episodes). 5 or less is considered normal for people.
--So in this study, they included anyone who was sleep and had mild apnea or worse. Just so you know, mild apnea is actually pretty common. I see 20, 30, 40, 50 events per hour on sleep studies all the time, which is moderate and severe apnea.
--They divided these people into two groups; some got CPAP therapy at home to fix their apnea, and half got a fake mask treatment so their apnea continued.
--They followed them for three months to see what happened.
--In the group treated with FAKE treatment, NOTHING improved
--In the group treated with CPAP, the following GOT SIGNIFICANTLY BETTER: systolic blood pressure, diastolic blood pressure, blood sugar, total cholesterol, "good" cholesterol, "bad" cholesterol, triglycerides... almost everything essentially. The only thing that didn't get better in the 3 month trial was waist circumference, but what can you really expect in only three months?.... well, a lot it seems.
--The people who used CPAP more during the night had better improvement in their numbers
--Lastly, just to double-check, at the end of the study, they switched the groups, treating the fake CPAP group now with REAL CPAP and treating the prior REAL CPAP group with the fake CPAP and watched all the things above follow the same trend of improvement (if treated with CPAP again for another three months)

Oh, and 13% of the people with metabolic syndrome... NO LONGER HAD METABOLIC SYNDROME AT THE END OF THREE MONTHS with the only change being using CPAP to resolve their apnea.

Read the longer version below if you would like:
CPAP Improves Metabolic Syndrome in Apnea Patients

Blood pressure and metabolic abnormalities improved significantly in patients with obstructive sleep apnea treated with continuous positive airway pressure (CPAP), results of a randomized, crossover trial showed.
Systolic and diastolic blood pressure, lipids, and glycated hemoglobin all responded favorably to three months of CPAP as compared with sham CPAP (P=0.02 to P<0.001).
By the end of the study, 13% of patients treated with CPAP no longer met diagnostic criteria for metabolic syndrome, compared with 1% of patients in the sham-CPAP control group, as reported in the Dec. 15 issue of the New England Journal of Medicine.
"CPAP is the first-line treatment for moderately severe obstructive sleep apnea and may be useful for treating the metabolic syndrome or metabolic abnormalities associated with obstructive sleep apnea," Surendra K. Sharma, MD, PhD, of the All India Institute of Medical Sciences in New Delhi, and co-authors wrote in the discussion of their findings.
"As compared with patients in other studies, our patients had more severe metabolic derangements at baseline, which could be one reason for the better response to CPAP therapy," they added.
CPAP was also associated with significant weight loss, which might have contributed to improvement in metabolic parameters.
Estimates of obstructive sleep apnea prevalence have ranged as high as 24% for men and 9% for women. The sleep disorder frequently is associated with metabolic syndrome, with estimates as high as 85% of patients with obstructive apnea and 41% of patients with nonobstructive apnea, according to the article's background information.
CPAP is first-line therapy for symptomatic obstructive sleep apnea and has demonstrated high rates of efficacy in adherent patients. Studies of the treatment's effects on metabolic syndrome have yielded mixed results. Most have shown favorable effects on blood pressure, but data on insulin resistance and lipids have been inconsistent and even conflicting, the authors continued.
In an effort to clarify the effects of CPAP on metabolic abnormalities, Sharma and colleagues conducted a randomized clinical trial involving patients with obstructive sleep apnea and one or more metabolic abnormalities. The patients had apnea documented by overnight evaluation in a sleep laboratory (Apnea/Hypopnea Index score ≥5) and associated with daytime somnolence but no history of treatment with CPAP.
About 80% of the patients met diagnostic criteria for metabolic syndrome, as defined by the National Cholesterol Education Program (JAMA. 2001; 285: 2486-2497).
Patients were randomized to three months of at-home use of CPAP or sham CPAP, followed by a one-month washout period, then crossed over to the opposite treatment for an additional three months.
The final analysis included 86 patients. The patients had a mean age of 45 and all but nine were men. The population had a mean body mass index (BMI) of 32, and mean waist circumference exceeded 110 cm. Almost half of the patients had hypertension, a similar proportion had diabetes, and mean fasting glucose was about 106 mg/dL. More than 80% had some form of dyslipidemia.