Thunström Erik, Glantz Helena, Yucel-Lindberg Tülay, Lindberg Kristin, Saygin Mustafa, Peker Yüksel
Department of Molecular and Clinical Medicine, Institution of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Department of Internal Medicine, Skaraborg Hospital, Lidköping, Sweden.
Sleep. 2017 Nov 1;40(11). doi: 10.1093/sleep/zsx157.
Obstructive sleep apnea (OSA) and enhanced vascular inflammation coexist in patients with coronary artery disease (CAD). Continuous positive airway pressure (CPAP) is first-line treatment for OSA with daytime sleepiness. This analysis of data from the RICCADSA (Randomized Intervention with CPAP in Coronary Artery Disease and Sleep Apnea) trial investigated the effects of CPAP on inflammatory markers in patients with CAD and nonsleepy OSA.
This single-center, randomized, controlled, open-label trial enrolled consecutive revascularized patients with nonsleepy OSA (apnea-hypopnea index >15/h; Epworth Sleepiness Scale score <10). Levels of high-sensitivity C-reactive protein (hs-CRP), interleukin (IL)-6, IL-8, and tumor necrosis factor-α (TNF-α) were measured in blood samples taken at baseline (median 94 days after revascularization) and after 1 year of follow-up in patients randomized to CPAP or no-CPAP.
A total of 220 patients with analyzable blood samples at baseline and 1 year were included. Baseline IL-6 levels were significantly lower in the CPAP versus no-CPAP group (median 3.1 pmol/L [interquartile range 1.3-5.7] vs. 4.2 pmol/L [2.0-8.9], respectively; p = .005). At 1-year follow-up, median IL-6 levels were significantly reduced in both groups (to 2.2 pmol/L [1.2-3.9] in the CPAP group and to 2.2 [1.2-4.7] in no-CPAP group; both p < .001 vs. baseline). IL-8, hs-CRP, and TNF-α did not change significantly from baseline. There was no association between CPAP adherence and changes in inflammatory marker levels.
In patients with stable CAD and nonsleepy OSA, inflammatory biomarkers did not change significantly over time except for IL-6 levels, which reduced to the same extent in the CPAP and no-CPAP groups.
ClinicalTrials.gov, ID: NCT00519597; researchweb.org, VGSKAS-4731.
阻塞性睡眠呼吸暂停（OSA）与血管炎症增强在冠状动脉疾病（CAD）患者中共存。持续气道正压通气（CPAP）是治疗伴有日间嗜睡的OSA的一线疗法。这项对RICCADSA（冠状动脉疾病和睡眠呼吸暂停患者CPAP随机干预）试验数据的分析，研究了CPAP对CAD且无嗜睡症状的OSA患者炎症标志物的影响。
这项单中心、随机、对照、开放标签试验纳入了连续接受血运重建治疗且无嗜睡症状的OSA患者（呼吸暂停低通气指数>15次/小时；爱泼沃斯嗜睡量表评分<10分）。在基线时（血运重建后中位数94天）以及随机分配至CPAP组或非CPAP组的患者随访1年后采集的血样中，检测高敏C反应蛋白（hs-CRP）、白细胞介素（IL）-6、IL-8和肿瘤坏死因子-α（TNF-α）的水平。
共有220例患者在基线和1年时具有可分析的血样。CPAP组的基线IL-6水平显著低于非CPAP组（中位数分别为3.1皮摩尔/升[四分位间距1.3 - 5.7]和4.2皮摩尔/升[2.0 - 8.9]；p = 0.005）。在1年随访时，两组的IL-6中位数水平均显著降低（CPAP组降至2.2皮摩尔/升[1.2 - 3.9]，非CPAP组降至2.2[1.2 - 4.7]；与基线相比，p均<0.001）。IL-8、hs-CRP和TNF-α与基线相比无显著变化。CPAP依从性与炎症标志物水平变化之间无关联。
在稳定型CAD且无嗜睡症状的OSA患者中，除IL-6水平外，炎症生物标志物随时间无显著变化，且CPAP组和非CPAP组的IL-6水平下降程度相同。
ClinicalTrials.gov，标识符：NCT00519597；researchweb.org，VGSKAS - 4731。
