Continuous positive airway pressure therapy and carbohydrate and lipid metabolism in patients with Z syndrome
Abstract
Aim. To examine continuous positive airway pressure (CPAP) therapy effects on carbohydrate and lipid metabolism in patients with metabolic syndrome (MS) and obstructive sleep apnea syndrome (OSAS).
Material and methods. The study involved 62 MS patients: 20 females and 42 males, aged 39-66 years (mean age 52.4±7.6 years). Control group included 15 patients without OSAS, another 47 had OSAS of varying severity (main group). CPAP therapy was administered to 11 OSAS patients for 12 weeks. At baseline and 12 weeks later, height, body weight (BW), waist and hips circumference (WC, HC) were measured, with body mass index calculation (BMI); levels of total cholesterol (TCH), high-density lipoprotein (HDL) CH, triglycerides (TG), glucose, leptin, resistin, adiponectin were assessed; glucose tolerance test and 24-hour blood pressure (BP) monitoring were performed.
Results. BW, BMI, WC, WC/HC, TCH decrease wasn’t statistically significant. HDL CH level increased from 0.99±0.2 to 1.12±0.1 mmol/l (р<0.05). TG concentration decreased from 4.18±3.3 to 2.31±1.2 mmol/l (р<0.05). Fasting glucose level fell from 5.8±0.8 to 5.3±0.3 mmol/l (р<0.05), and after glucose load test – from 8.3±1.8 to 6.5±1.9 mmol/l (р<0.05). Adipocytokine levels significantly improved: leptin level decreased from 15.14±4.6 to 11.17±5.2 ng/ml (р<0.05); resistin concentration – from 3.02±0.87 to 2.5±0.51 ng/ml (p<0.05), and adiponectin level increased form 2.44±0.6 to 3.34±0.9 ng/ml (p<0.05).
Conclusion. Effective CPAP therapy significantly improved metabolic parameters in patients with MS and OSAS.
About the Authors
R. A. Galyavi
A.L. Myasnikov Research Institute of Clinical Cardiology, Russian Cardiology Scientific and Clinical Complex, Russian Federal Agency of Health and Social Development, Moscow
Russian Federation
Russian Federation
A. Yu. Litvin
A.L. Myasnikov Research Institute of Clinical Cardiology, Russian Cardiology Scientific and Clinical Complex, Russian Federal Agency of Health and Social Development, Moscow
Russian Federation
Russian Federation
I. E. Chazova
A.L. Myasnikov Research Institute of Clinical Cardiology, Russian Cardiology Scientific and Clinical Complex, Russian Federal Agency of Health and Social Development, Moscow
Russian Federation
Russian Federation
References
1. Calle EE, Thun MJ, Petrelli JM, et al. Body-mass index and mortality in a prospective cohort of U.S. adults. N Engl J Med 1999; 341: 1097-105.
2. Vgontzas AN, Tan TL, Bixler EO, et al. Sleep apnea and sleep disruption in obese patients. Arch Intern Med 1994; 154: 1705-11.
3. Young T, Palta M, Dempsey J, et al. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 1993; 328: 1230-5.
4. Shinohara E, Kihara S, Yamashita S, et al. Visceral fat accumulation as an important risk factor for obstructive sleep apnoea syndrome in obese subjects. J Intern Med 1997; 241(1): 11-8.
5. Barvaux VA, Aubert G, Rodenstein DO. Weight loss as a treatment for obstructive sleep apnoea. Sleep Med Rev 2000; 4: 435-52.
6. Strobel RJ, Rosen RC. Obesity and weight loss in obstructive sleep apnea: a critical review. Sleep 1996; 19: 104-15.
7. Mantzoros CS. The Role of Leptin in Human Obesity and Disease: A Review of Current Evidence. Ann Intern Med 1999; 130: 671-80.
8. Tritos NA, Mantzoros CS. Leptin: its role in obesity and beyond. Diabetologia 1997; 40: 1371-9.
9. Zhang Y, Proenca R, Maffei M, et al. Positional cloning of the mouse obese gene and its human homologue. Nature 1994; 372: 425-32.
10. Erickson JC, Hollopeter G, Palmiter RD. Attenuation of the obesity syndrome of ob/ob mice by the loss of neuropeptide Y Science 1996; 274: 1704-7.
11. Stephens TW, Basinski M, Bristow PK, et al. The role of neuropeptide Y in the antiobesity action of the obese gene product. Nature 1995; 377: 530-2.
12. Shimabukuro M, Koyama K, Chen G, et al. Direct antidiabetic effect of leptin through triglyceride depletion of tissues. Proc Natl Acad Sci USA 1997; 94: 4637-41.
13. Friedman JM. Leptin, leptin receptors, and the control of body weight. Nutr Rev 1998; 56(2 Pt 2): S38-46.
14. Lyon CJ, Law RE, Hsueh WA. Minireview: adiposity, in-flammation and atherogenesis. Endocrinology 2003; 144: 2195-200.
15. Scherer PE, Williams S, Fogliano M, et al. A novel serum protein similar to C1q, produced exclu-sively in adipocytes. J Biol Chem 1995; 270: 26746-9.
16. Ouchi N, Kihara S, Arita Y, et al. Novel modulator for endothelial adhesion molecules: adipocyte-derived plasma protein adiponectin. Circulation 1999; 100: 2473-6.
17. Bannerjee RR, Lazar MA. Dimerization of resistin and resistinlike molecules is determined by a single cysteine. J Biol Chem 2001; 276: 25970-3.
18. Savage DB, Sewter CK, Klenk ES, et al. Resistin/Fizz3 expression in relation to obesity and peroxisome proliferator-activated receptor-gamma action in humans. Diabetes 2001; 50: 2199-202.
19. Janke J, Engeli S, Gorzelniak K, et al. Resistin gene expression in human adipocytes is not related to insulin resistance. Obes Res 2002; 10: 1-5.
20. Hedner J, Holger K, Yuksel Peker. Reduction of Sleep-disordered Breathing after Physostigmine American Journal of Respiratory and Critical Care Medicine 2003; 168: 1246-51.
21. Weiss JW, Remsburg S, Garpestad E, et al. Hemodynamic consequences of obstructive sleep apnea. Sleep 1996; 19: 388-97.
22. Hedner J, Ejnell H, Sellgren J, et al. Is high and fluctuating muscle nerve sympathetic activity in the sleep apnea syndrome of pathogenetic importance for the development of hypertension? J Hypertens 1988; 6: S529-31.
23. Fletcher EC, DeBehnke RD, Lovoi MS, et al. Undiagnosed sleep apnea in patients with essential hypertension. Ann Intern Med 1985; 103: 190-5.
24. Gruenstein R, Wilcox I, Yang TS, et al. Snoring and sleep apnoea in men: association with central obesity and hypertension. Int J Obesity 1993; 17: 533-40.
25. Бузунов Р.В. Синдром обструктивного апноэ сна в сочетании с ожирением: особенности патогенеза, диагностики и лечения. Москва 2003.
26. Cooper BG, White JE, Ashworth LA, et al. Hormonal and metabolic profiles in subjects with obstructive sleep apnea syndrome and the acute effects of nasal continuous positive airway pressure (CPAP) treatment. Sleep 1995; 18(3): 172-9.
27. Shimizu K, Chin K, Nakamura T, et al. Plasma leptin levels and cardiac sympathetic function in patients with obstructive sleep apnoea-hypopnoea syndrome. Thorax 2002; 57(5): 429-34.
28. Chin K, Shimizu K, Nakamura T, et al. Changes in intraabdominal visceral fat and serum leptin levels in patients with obstructive sleep apnea syndrome following nasal continuous positive airway pressure therapy. Circulation 1999; 100: 706-12.
29. Ip M; Lam KSL; Chung-man Ho, et al. Serum Leptin and Vascular Risk Factors in Obstructive Sleep Apnea. Chest 2000; 118: 580-6.
30. Sanner BM, Kollhosser P, Buechner N, et al. M Influence of treatment on leptin levels in patients with obstructive sleep apnoea. Eur Respir J 2004; 23(4): 601-4.
31. Harsch IA, Keebnick C, Wallaschofski H, et al. Resistin levels in patients with obstrtuctive sleep apnoea syndrome – the link to subclinical inflammations? Med Sci Monit 2004; 10(9): 510-6.
32. Harsch IA, Keebnick C, Wallaschofski H, et al. Adiponectin in patients with obstrtuctive sleep apnea syndrome: course and physiological relevance. Respiration 2004; 71: 580-6.
33. Weyer C, Funahashi T, Tanaka S, et al. Hypoadiponectinemia in obesity and type 2 diabetes: close asociation with insulin resistance and hyperinsulinemia. J Clin Endocrinol Metab 2001; 86: 1930-5.
34. Comuzzie AG, Funaha hi T, Sonnenberg G, et al: The genetic basis of plasma variation in adiponectin, a global endophenotype for obesity and the metabolic syndrome. J Clin Endocrinol Metab 2001; 86: 4321-5.
35. Dimsdale JE, Jose SL, Judi Profant. Effect of Continuous Positive Airway Pressure on Blood Pressure A Placebo Trial. Hypertension 2000; 35: 144-7.
36. Engleman HM, Gough K, Martin SE, et al. Ambulatory blood pressure on and off continuous positive airway pressure therapy for the sleep apnea/hypopnea syndrome: effects in “non-dippers.” Sleep 1996; 19: 378-81.
37. Suzuki M, Otsuka K, Guilleminault C. Long-term nasal continuous positive airway pressure administration can normalize hypertension in obstructive sleep apnea patients. Sleep 1993; 16: 545-9.
38. Worsnop CJ, Pierce RJ, Naughton M. Systemic hypertension and obstructive sleep apnea. Sleep 1993; 16: S148-9.
39. Logan AG, Tkacova R, Perlikowski SM, et al. Refractory hypertension and sleep apnoea: effect of CPAP on blood pressure and baroreflex. Eur Respir J 2003; 21(2): 241-7.
40. Barbe F, Mayoralas LR, Duran J, et al. Treatment with continuous positive airway pressure is not effective in patients with sleep apnea but no daytime sleepiness: a randomized, controlled trial. Ann Intern Med 2001; 134: 1015-23.
41. Ip M, Chung KF, Chan KN, et al. Previously unrecognized obstructive sleep apnea in Chinese subjects with essential hypertension. Lung 1999; 177(6): 391-400.
42. Faccenda JF, Mackay TW, Boon NA, et al. Randomized Placebocontrolled Trial of Continuous Positive Airway Pressure on Blood Pressure in the Sleep Apnea–Hypopnea Syndrome. Am J Respir Crit Care Med 2001; 163: 344-8.
43. Jennum P, Sjol A. Self – assessed cognitive function in snorers and sleep apneics. An epidemiological study of 1504 females and males aged 30-69 years: the Dan-MONICA II Study. Eur Neur 1994; 34: 204-8.
44. Sanner BM, Tepel M, Markmann A, et al. Effect of continuous positive airway pressure therapy on 24-hour blood pressure in patients with obstructive sleep apnea syndrome. Am J Hypertens 2002; 15(3): 251-7.
45. Pankow W, Lies A, Lohmann FW. Sleep-disordered breathing and hypertension. N Engl J Med 2000; 343: 966-70.
46. Nieto FJ, Young TB, Lind BK, et al. Association of sleepdisordered breathing, sleep apnea, and hypertension in a large community-based study. Sleep Heart Health Study. JAMA 2000; 283: 1829-36.
47. Young T, Peppard P, Palta M, et al. Population-based study of sleep-disordered breathing as a risk factor for hypertension. Arch Intern Med 1997; 157: 1746-52.
48. Hla KM, Skatrub B, Finn L, et al. The effect of correction of sleepdisorder breathing on BP in untreated hypertension. Chest 2002; 122: 1125-32.
Review
For citations:
Galyavi R.A., Litvin A.Yu., Chazova I.E. Continuous positive airway pressure therapy and carbohydrate and lipid metabolism in patients with Z syndrome. Cardiovascular Therapy and Prevention. 2005;4(6, ч.I):67-75. (In Russ.)
Views:
633
Email this article 
