Effects of Continuous Positive Airway Pressure on Body Composition in Individuals with Obstructive Sleep Apnea: A Non-Randomized, Matched Before-After Study.

Ari Shechter,Marie-Pierre St-Onge,Nicholas C Dugas,Jordan Valentin,Irene K Louh,Marwah Abdalla,Michael Airo

doi:10.3390/jcm8081195

Abstract

A reciprocal relationship between obesity and obstructive sleep apnea (OSA) likely exists, wherein obesity contributes to OSA, and OSA-related sleep disturbances promote weight gain. It remains unclear whether continuous positive airway pressure (CPAP) affects body composition. We conducted an open-label, parallel-arm, non-randomized, matched before-after study in individuals with OSA who were starting CPAP use (n = 12) and who were not (n = 12) to examine the effects of CPAP on total body composition (via air displacement plethysmography) including fat and fat-free mass. CPAP users (n = 12) were studied at baseline and after 8 weeks of CPAP use, and 12 age- and sex-matched non-CPAP OSA controls were studied at baseline and after an 8 week period. Statistically significant group x time interactions were seen for body weight, fat-free mass, and fat-mass, such that body weight and fat-free mass were increased, and fat mass decreased, at 8-week follow-up in the CPAP group compared to baseline. Body weight and body composition measures were unchanged in the non-CPAP control group. These findings are consistent with prior studies showing CPAP-induced weight gain, and suggest that weight gain observed following CPAP may be driven primarily by increases in fat-free mass. An increase in lean mass (and decrease in fat mass), despite an overall increase in body weight, can be considered a favorable metabolic outcome in response to CPAP use.

Highlights

Obstructive sleep apnea (OSA) is associated with increased risk for cardiometabolic morbidities including hypertension, type 2 diabetes, coronary artery disease events and cardiovascular death [1,2,3,4,5,6]
Continuous positive airway pressure (CPAP) and controls were matched for age, body mass index (BMI), sex, and baseline AHI (Table 1)
A statistically significant group x time interaction was seen for body weight (p = 0.04, Table 2): values were higher at follow-up vs. baseline in CPAP (p = 0.01), but unchanged in controls (p = 0.82)

Summary

Introduction

Obstructive sleep apnea (OSA) is associated with increased risk for cardiometabolic morbidities including hypertension, type 2 diabetes, coronary artery disease events and cardiovascular death [1,2,3,4,5,6]. Continuous positive airway pressure (CPAP) is an established treatment for OSA. While the effectiveness of CPAP in preventing cardiovascular events remains controversial [11,12], CPAP use has been shown to improve sleep quality [13], reduce daytime sleepiness [14], increase health-related quality of life [15], and lower blood pressure [16]. Whether, and how CPAP use affects body weight in individuals with OSA is controversial. Most studies have focused on body weight, as opposed to other relevant aspects of body composition like fat mass and fat-free/lean mass

Methods

Results

Discussion

Conclusion