持续气道正压通气治疗阻塞性睡眠呼吸暂停降低循环脂肪细胞脂肪酸结合蛋白：一项随机对照研究。

Circulating adipocyte fatty acid-binding protein is reduced by continuous positive airway pressure treatment for obstructive sleep apnea-a randomized controlled study.

机构信息

Division of Respiratory and Critical Care Medicine, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Pokfulam, Hong Kong SAR, China.

出版信息

Sleep Breath. 2020 Sep;24(3):817-824. doi: 10.1007/s11325-019-01893-5. Epub 2019 Aug 1.

DOI:10.1007/s11325-019-01893-5

PMID:31372823

Abstract

PURPOSE

The circulating level of adipocyte fatty acid-binding protein (AFABP), a biomarker with prognostic and therapeutic importance in metabolic disorders, has been shown to be elevated in obstructive sleep apnea (OSA). This randomized controlled study aimed to investigate the effect of continuous positive airway pressure (CPAP) treatment for OSA on AFABP levels.

METHODS

Consecutive subjects attending sleep study were invited if they were confirmed to have severe OSA and were free of metabolic diseases. Participants were randomized (1:1) into CPAP or observation group for 4 weeks. Demographics, anthropometric data, and circulating biomarkers were checked at baseline and after the 4-week study period.

RESULTS

Ninety subjects were randomized. The mean age was 46 ± 9 years old; 82% were male. Their mean body mass index (BMI) was 29 ± 5 kg/m. By intention-to-treat approach, the CPAP group showed significant reductions in Epworth sleepiness scale and morning systolic blood pressure (- 7.2 mmHg, - 12.7 to - 1.7 mmHg, p = 0.011), but no significant difference in AFABP, adiponectin, C-reactive protein (CRP), and 8-isoprostane levels. In the per-protocol analysis, when only those who were compliant to CPAP were included, a significant reduction in AFABP (- 7.32 ng/ml, - 13.58, - 1.06, p = 0.023) were found in the CPAP-treated group compared with the control group, along with improvements in clinical parameters. Changes in AFABP were independently associated with both systolic blood pressure (β = 0.289, p = 0.028) and diastolic blood pressure (β = 0.217, p = 0.030).

CONCLUSION

CPAP therapy used regularly over 4 weeks for severe OSA lowered circulating AFABP level, suggesting a potential beneficial effect of OSA treatment on alleviating metabolic risks.

TRIAL REGISTRATION

The research protocol was registered at the National Institutes of Health clinical trials registry (NCT01173432).

摘要

目的

脂肪细胞脂肪酸结合蛋白（AFABP）是一种具有代谢疾病预后和治疗重要性的生物标志物，其循环水平在阻塞性睡眠呼吸暂停（OSA）中升高。本随机对照研究旨在探讨持续气道正压通气（CPAP）治疗 OSA 对 AFABP 水平的影响。

方法

如果连续受试者经睡眠研究证实患有严重 OSA 且无代谢疾病，则邀请他们参加。参与者按 1:1 随机分为 CPAP 或观察组，进行 4 周研究。在基线和 4 周研究期后检查人口统计学、人体测量学数据和循环生物标志物。

结果

90 名受试者被随机分配。平均年龄为 46±9 岁；82%为男性。他们的平均体重指数（BMI）为 29±5kg/m。通过意向治疗方法，CPAP 组的嗜睡量表评分和清晨收缩压显著降低（-7.2mmHg，-12.7 至-1.7mmHg，p=0.011），但 AFABP、脂联素、C 反应蛋白（CRP）和 8-异前列腺素水平无显著差异。在方案分析中，当仅纳入依从 CPAP 治疗的患者时，CPAP 治疗组的 AFABP 显著降低（-7.32ng/ml，-13.58，-1.06，p=0.023），同时临床参数也得到改善。AFABP 的变化与收缩压（β=0.289，p=0.028）和舒张压（β=0.217，p=0.030）独立相关。