Abstract
Background: Obstructive sleep apnea (OSA) is associated with dyslipidemia. However, the effects of continuous positive airway pressure (CPAP) treatment on lipid profiles are unclear. Methods: PubMed/Medline, Embase and Cochrane were searched up to July 2021. Randomized controlled trials (RCTs) of CPAP versus controls with ≥4 weeks treatment and reported pre- and post-intervention lipid profiles were included. Weighted mean difference (WMD) was used to assess the effect size. Meta-regression was used to explore the potential moderators of post-CPAP treatment changes in lipid profiles. Results: A total of 14 RCTs with 1792 subjects were included. CPAP treatment was associated with a significant decrease in total cholesterol compared to controls (WMD = −0.098 mmol/L, 95% CI = −0.169 to −0.027, p = 0.007, I2 = 0.0%). No significant changes in triglyceride, high-density lipoprotein nor low-density lipoprotein were observed after CPAP treatment (all p > 0.2). Furthermore, meta-regression models showed that age, gender, body mass index, daytime sleepiness, OSA severity, follow-up study duration, CPAP compliance nor patients with cardiometabolic disease did not moderate the effects of CPAP treatment on lipid profiles (all p > 0.05). Conclusions: CPAP treatment decreases total cholesterol at a small magnitude but has no effect on other markers of dyslipidemia in OSA patients. Future studies of CPAP therapy should target combined treatment strategies with lifestyle modifications and/or anti-hyperlipidemic medications in the primary as well as secondary cardiovascular prevention models.
Highlights
Obstructive sleep apnea (OSA) is one of the most common sleep disorders in adults, affecting nearly 1 billion individuals worldwide [1]
After publication of the three aforementioned meta-analyses, new Randomized controlled trials (RCTs) with longer follow-up durations have been published. Because both OSA and dyslipidemia are highly associated with cardiometabolic disease [24,25,26], here is a need for an update to address the effect of continuous positive airway pressure (CPAP) on lipid profiles in OSA, which was the rationale for the current study
To explore the potential moderators of change in lipid profiles after CPAP treatment, meta-regression models were performed by using TC, TG, HDL and LDL as the outcomes and using age, male percentage, body mass index (BMI), obesity, Epworth Sleepiness Scale (ESS), apnea–hypopnea index (AHI), follow-up duration, CPAP compliance and studies that recruited only patients with cardiometabolic diseases patients as independent variables, respectively, according to possible clinical relevance
Summary
Obstructive sleep apnea (OSA) is one of the most common sleep disorders in adults, affecting nearly 1 billion individuals worldwide [1]. A meta-analysis including 6 randomized controlled trials (RCTs) with 741 participants showed that CPAP treatment decreased total cholesterol (TC) for 0.15 mmol/L, but no changes in levels of low-density lipoprotein (LDL), high-density lipoprotein (HDL) nor triglyceride (TG) [15] were observed. Most RCTs included in these two meta-analyses have relatively short follow-up durations, i.e., over 80% included RCTs with follow-up durations shorter than 24 weeks Another meta-analysis including 29 cohort studies with 1958 participants showed that CPAP treatment decreased TC and LDL and increased HDL [22]. After publication of the three aforementioned meta-analyses, new RCTs with longer follow-up durations have been published Because both OSA and dyslipidemia are highly associated with cardiometabolic disease [24,25,26], here is a need for an update to address the effect of CPAP on lipid profiles in OSA, which was the rationale for the current study
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