Schmoller Andre, Eberhardt Frank, Jauch-Chara Kamila, Schweiger Ulrich, Zabel Peter, Peters Achim, Schultes Bernd, Oltmanns Kerstin M
Department of Psychiatry and Psychotherapy, University of Luebeck, D-23538 Germany.
Metabolism. 2009 Jun;58(6):848-53. doi: 10.1016/j.metabol.2009.02.014.
Patients with obstructive sleep apnea syndrome (OSAS) show recurrent episodes of nightly hypoxic stress. The purpose of this study is the detection of alterations of the hypothalamic-pituitary-adrenal stress axis in OSAS patients before and after continuous positive airway pressure (CPAP) therapy. An activation of the hypothalamic-pituitary-adrenal axis was proposed because of the nightly hypoxic stress in these patients, but previous studies were not conclusive. Here we hypothesize that CPAP therapy decreases salivary cortisol concentrations in patients with severe OSAS. We performed a clinical within-subject study including 50 patients with newly diagnosed OSAS and an apnea-hypopnea index greater than or equal to 40 h(-1). Diurnal profiles of salivary cortisol concentrations were compiled before and after 3 months of treatment with CPAP. Therefore, 6 cortisol samples were collected: before and after lunch, in the evening, the next morning after awakening, and before and after breakfast. Thirty-eight patients returned after 3 months of CPAP therapy for follow-up. According to the reference range for healthy subjects, cortisol values were not pathologically increased. Analysis of variance revealed a significant effect of CPAP therapy on diurnal cortisol profiles (P = .048). Subjects with severe OSAS showed a decrease (3.04 +/- 0.55 nmol L(-1) pre-CPAP vs 2.48 +/- 0.78 nmol L(-1) post-CPAP, P = .038) of evening cortisol levels after CPAP treatment, whereas prelunch levels were increased after CPAP therapy (7.18 +/- 0.83 nmol L(-1) pre-CPAP vs 10.22 +/- 1.10 nmol L(-1) post-CPAP, P = .044). Our results show that CPAP therapy decreases evening cortisol concentrations in patients with severe OSAS. These data suggest that OSAS may increase the cortisol nadir that is reversed after CPAP therapy.
阻塞性睡眠呼吸暂停综合征（OSAS）患者夜间反复出现低氧应激发作。本研究的目的是检测持续气道正压通气（CPAP）治疗前后OSAS患者下丘脑-垂体-肾上腺应激轴的变化。由于这些患者夜间存在低氧应激，有人提出下丘脑-垂体-肾上腺轴被激活，但先前的研究尚无定论。在此我们假设CPAP治疗可降低重度OSAS患者的唾液皮质醇浓度。我们进行了一项临床自身对照研究，纳入50例新诊断的OSAS患者，其呼吸暂停低通气指数大于或等于40次/小时（h⁻¹）。在CPAP治疗3个月前后收集唾液皮质醇浓度的昼夜变化数据。因此，共采集6份皮质醇样本：午餐前、午餐后、晚上、次日早晨醒来后、早餐前和早餐后。38例患者在CPAP治疗3个月后返回进行随访。根据健康受试者的参考范围，皮质醇值没有病理性升高。方差分析显示CPAP治疗对昼夜皮质醇水平有显著影响（P = 0.048）。重度OSAS患者在CPAP治疗后夜间皮质醇水平下降（CPAP治疗前为3.04±0.55 nmol/L，治疗后为2.48±0.78 nmol/L，P = 0.038），而午餐前皮质醇水平在CPAP治疗后升高（CPAP治疗前为7.18±0.83 nmol/L，治疗后为10.22±1.10 nmol/L，P = 0.044）。我们的结果表明，CPAP治疗可降低重度OSAS患者夜间皮质醇浓度。这些数据表明，OSAS可能会增加皮质醇最低点，而CPAP治疗后这种情况会得到逆转。
