BACKGROUND: The mechanisms by which obesity and obstructive sleep apnoea (OSA) may contribute to endothelial dysfunction are unclear. AIMS: We sought to follow up a sample of obese subjects undergoing either bariatric surgery or continuous positive airway pressure (CPAP) therapy to treat OSA. We hypothesised improved vascular function with both therapeutic approaches, consistent with a reversible OSA effect on the circulation. METHODS: Twenty-seven obese (BMI ≥30 kg/m(2)) subjects with OSA underwent either bariatric surgery without CPAP (n = 12, median BMI 43.7 kg/m(2) IQR 9.4) or CPAP (n = 15, median BMI 33.8 kg/m(2) IQR 6.6). Polysomnography and vascular testing (flow-mediated dilation of the brachial artery measured with high-resolution ultrasound, endothelium-dependent change in skin blood flow measured with laser Doppler flowmetry, and arterial stiffness measured with applanation tonometry) took place at baseline and after 6 months. RESULTS: Both groups showed significant improvements in the apnoea-hypopnea index and overnight oxygen saturation. Endothelium-dependent microvascular reactivity was 45.6% (IQR 37.5) at baseline in the CPAP group, which increased to 69.1% (IQR 62.3) post-treatment (P < 0.05). No significant changes were observed in the surgery group, despite significant weight loss (post-surgery BMI 32.7 kg/m2 IQR 8.6 (P < 0.01); no change in BMI was observed in the CPAP group. There were no significant changes in brachial artery flow-mediated dilation in either group. CONCLUSIONS: This pilot study demonstrates that 6 months of CPAP may be sufficient to improve endothelium-dependent microvascular reactivity, while substantial surgically induced weight loss did not result in improvements. Further research should be directed towards comparative effectiveness trials using these novel surrogate outcomes, as well as hard cardiovascular outcomes.
BACKGROUND: The mechanisms by which obesity and obstructive sleep apnoea (OSA) may contribute to endothelial dysfunction are unclear. AIMS: We sought to follow up a sample of obese subjects undergoing either bariatric surgery or continuous positive airway pressure (CPAP) therapy to treat OSA. We hypothesised improved vascular function with both therapeutic approaches, consistent with a reversible OSA effect on the circulation. METHODS: Twenty-seven obese (BMI ≥30 kg/m(2)) subjects with OSA underwent either bariatric surgery without CPAP (n = 12, median BMI 43.7 kg/m(2) IQR 9.4) or CPAP (n = 15, median BMI 33.8 kg/m(2) IQR 6.6). Polysomnography and vascular testing (flow-mediated dilation of the brachial artery measured with high-resolution ultrasound, endothelium-dependent change in skin blood flow measured with laser Doppler flowmetry, and arterial stiffness measured with applanation tonometry) took place at baseline and after 6 months. RESULTS: Both groups showed significant improvements in the apnoea-hypopnea index and overnight oxygen saturation. Endothelium-dependent microvascular reactivity was 45.6% (IQR 37.5) at baseline in the CPAP group, which increased to 69.1% (IQR 62.3) post-treatment (P < 0.05). No significant changes were observed in the surgery group, despite significant weight loss (post-surgery BMI 32.7 kg/m2 IQR 8.6 (P < 0.01); no change in BMI was observed in the CPAP group. There were no significant changes in brachial artery flow-mediated dilation in either group. CONCLUSIONS: This pilot study demonstrates that 6 months of CPAP may be sufficient to improve endothelium-dependent microvascular reactivity, while substantial surgically induced weight loss did not result in improvements. Further research should be directed towards comparative effectiveness trials using these novel surrogate outcomes, as well as hard cardiovascular outcomes.
Authors: Mary C Corretti; Todd J Anderson; Emelia J Benjamin; David Celermajer; Francois Charbonneau; Mark A Creager; John Deanfield; Helmut Drexler; Marie Gerhard-Herman; David Herrington; Patrick Vallance; Joseph Vita; Robert Vogel Journal: J Am Coll Cardiol Date: 2002-01-16 Impact factor: 24.094
Authors: Malcolm Kohler; Anne-Christin Stoewhas; Lisa Ayers; Oliver Senn; Konrad E Bloch; Erich W Russi; John R Stradling Journal: Am J Respir Crit Care Med Date: 2011-11-15 Impact factor: 21.405
Authors: A Veves; R Saouaf; V M Donaghue; C A Mullooly; J A Kistler; J M Giurini; E S Horton; R A Fielding Journal: Diabetes Date: 1997-11 Impact factor: 9.461
Authors: F Javier Nieto; David M Herrington; Susan Redline; Emelia J Benjamin; John A Robbins Journal: Am J Respir Crit Care Med Date: 2003-10-09 Impact factor: 21.405
Authors: Panagis Drakatos; Sean Higgins; Martino F Pengo; Brian D Kent; Rex Muza; Kiriakos Karkoulias; Guy Leschziner; Adrian Williams Journal: J Clin Sleep Med Date: 2016-02 Impact factor: 4.062
Authors: Jessie P Bakker; Dimitrios Baltzis; Francesco Tecilazich; Raymond H Chan; Warren J Manning; Tomas G Neilan; Meredith L Wallace; Margo Hudson; Atul Malhotra; Sanjay R Patel; Aristidis Veves Journal: Ann Am Thorac Soc Date: 2020-04
Authors: Monika A Proczko; Pieter S Stepaniak; Marcel de Quelerij; Floor Haak van der Lely; J Frans Smulders; Lukasz Kaska; Mohammed A Soliman Hamad Journal: J Anesth Date: 2014-05-29 Impact factor: 2.078
Authors: David Kent; Jeffrey Stanley; R Nisha Aurora; Corinna G Levine; Daniel J Gottlieb; Matthew D Spann; Carlos A Torre; Katherine Green; Christopher G Harrod Journal: J Clin Sleep Med Date: 2021-12-01 Impact factor: 4.062