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CPAP therapy induces favorable short-term changes in epicardial fat thickness and vascular and metabolic markers in apparently healthy subjects with obstructive sleep apnea-hypopnea syndrome (OSAHS)

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Abstract

Background

Obstructive sleep apnea-hypopnea syndrome (OSAHS) is an independent risk factor for hypertension, coronary artery disease, and diabetes mellitus. Epicardial fat has been recently recognized as a new risk factor and active participant on cardiometabolic risk. The aim of this study was to assess an independent relationship between sleep apnea severity, metabolic and vascular markers, and epicardial fat, at baseline and after 3 months of continuous positive airway pressure (CPAP) therapy.

Materials and method

Our study group consisted of 48 patients with suspected OSAHS and no prior history of cardiovascular disease or diabetes mellitus. All patients underwent full overnight polysomnography. Thickness of epicardial and visceral adipose tissue, brachial artery flow-mediated dilation (FMD), carotid intima media thickness (cIMT), pulse wave velocity (PWV), plasma C-reactive protein (CRP) levels, fasting glucose levels, HbA1c, homeostatic model assessment of insulin resistance index (HOMA), and lipid profile were measured at baseline and after 3 months of CPAP use in patients with moderate to severe OSAHS.

Results

In OSAHS patients (Apnea-hypopnea index (AHI) ≥15/h, N = 28), epicardial fat correlated with fasting glucose (rho = 0.406, p = 0.04) and HOMA (rho = 0.525, p = 0.049) but was not associated with visceral fat (rho = 0.126, p = 0.595). Epicardial adipose tissue (EAT) (p = 0.022) increased across AHI severity along with PWV (p = 0.045) and carotid intima media thickness (IMT) (p = 0.034) while FMD (p = 0.017) decreased. Therapy with CPAP reduced both epicardial (p < 0.001) and visceral fat (p = 0.001). Alterations in epicardial fat across the follow-up were associated with changes in PWV (p = 0.026) and HOMA (p = 0.037) independently of major confounders.

Conclusions

Epicardial fat thickness was associated with OSA severity and may be an additional marker of cardiovascular risk as well as of future diabetes in these patients. CPAP therapy reduced epicardial fat, suggesting its potentially beneficial role in reducing cardiometabolic risk in OSA patients.

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Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent licensing arrangements) or nonfinancial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript.

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Authors and Affiliations

  1. Therapeutic Clinic Alexandra, Hospital University of Athens, Athens, Greece

    Konstantinos Kostopoulos, Emmanouil Alhanatis, Konstantinos Pampoukas, Georgios Georgiopoulos, Andromahi Zourla, Athanasios Panoutsopoulos, Anastasios Kallianos, Lemonia Velentza & Georgia Trakada

  2. Pulmonary Department-Oncology Unit, “G. Papanikolaou” General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece

    Paul Zarogoulidis

  3. Department of Interventional Pneumology, Ruhrlandklinik, University Hospital Essen, University of Essen-Duisburg, Tueschener Weg 40, 45239, Essen, Germany

    Paul Zarogoulidis

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  1. Konstantinos Kostopoulos
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  2. Emmanouil Alhanatis
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  3. Konstantinos Pampoukas
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  4. Georgios Georgiopoulos
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  5. Andromahi Zourla
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  6. Athanasios Panoutsopoulos
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  7. Anastasios Kallianos
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  8. Lemonia Velentza
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  9. Paul Zarogoulidis
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  10. Georgia Trakada
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Corresponding author

Correspondence to Paul Zarogoulidis.

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Comment

This study underlines the fact that obstructive sleep apnea is more than a mechanical problem: it should be classified as a systemic disease.

Bernd Sanner

Wuppertal, Germany

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Kostopoulos, K., Alhanatis, E., Pampoukas, K. et al. CPAP therapy induces favorable short-term changes in epicardial fat thickness and vascular and metabolic markers in apparently healthy subjects with obstructive sleep apnea-hypopnea syndrome (OSAHS). Sleep Breath 20, 483–493 (2016). https://doi.org/10.1007/s11325-015-1236-5

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