E Silva Luciana Oliveira, Guimarães Thais Moura, Pontes Gabriela, Coelho Glaury, Badke Luciana, Fabbro Cibele Dal, Tufik Sergio, Bittencourt Lia, Togeiro Sonia
Departamento de Psicobiologia, Universidade Federal de São Paulo, Rua Napoleão de Barros, 925, Vila Clementino, São Paulo, CEP 04021-002, Brazil.
Departamento de Pneumologia, Universidade Federal de São Paulo, São Paulo, Brazil.
Sleep Breath. 2021 Jun;25(2):797-805. doi: 10.1007/s11325-020-02183-1. Epub 2021 Jan 4.
Moderate and severe obstructive sleep apnea (OSA) have been independently associated with dyslipidemia. The results of metabolic improvement with continuous positive airway pressure (CPAP) have been controversial. Less evidence exists regarding this issue in mild OSA. A current treatment for mild OSA is mandibular advancement device (MAD) therapy, but its effectiveness on the metabolic profile needs to be compared with CPAP. The purpose of this study was to compare MAD vs CPAP vs no treatment on the metabolic profile during 6 and 12 months of follow-up in patients with mild OSA.
The inclusion criteria were patients with mild OSA, both genders, ages 18 to 65 years, and body mass index (BMI) of < 35 Kg/m. Patients were randomized in 3 groups (CPAP, MAD, and control). The evaluations included physical examination, metabolic profile, and full polysomnography at baseline, 6 months, and 12 months of follow-up.
Seventy-nine patients with mild OSA were randomized in three treatment groups, with mean age (± SD) of 47 ± 9 years, 54% men, and AHI 9.5 ± 2.9 events/h. MAD and CPAP reduced AHI at 6 and 12 months compared to the control group. MAD adherence was higher than CPAP at 6 and 12 months. Despite lower adherence compared to MAD, CPAP was more effective in reducing total cholesterol over 12 months (baseline 189.3 ± 60.2 mg/dl to 173.4 ± 74.3 mg/dl) and low-density lipoprotein cholesterol (LDL-c, baseline 112.8 ± 54.9 mg/dl to 94.5 ± 67.4 mg/dl).
After 1 year of treatment, CPAP was superior to MAD in reducing total cholesterol and LDL-c in patients with mild OSA.
中度和重度阻塞性睡眠呼吸暂停（OSA）已被独立证明与血脂异常有关。持续气道正压通气（CPAP）治疗代谢改善的结果一直存在争议。关于轻度OSA在这方面的证据较少。目前治疗轻度OSA的方法是下颌前移装置（MAD）治疗，但其对代谢指标的有效性需要与CPAP进行比较。本研究的目的是比较轻度OSA患者在6个月和12个月随访期间，MAD与CPAP及不治疗对代谢指标的影响。
纳入标准为轻度OSA患者，年龄18至65岁，性别不限，体重指数（BMI）<35 Kg/m²。患者被随机分为3组（CPAP组、MAD组和对照组）。评估包括在基线、随访6个月和12个月时进行体格检查、代谢指标检查和全夜多导睡眠监测。
79例轻度OSA患者被随机分为三个治疗组，平均年龄（±标准差）为47±9岁，男性占54%，呼吸暂停低通气指数（AHI）为9.5±2.9次/小时。与对照组相比，MAD组和CPAP组在6个月和12个月时AHI降低。在6个月和12个月时，MAD的依从性高于CPAP。尽管CPAP的依从性低于MAD，但在12个月内CPAP在降低总胆固醇（基线189.3±60.2mg/dl降至173.4±74.3mg/dl）和低密度脂蛋白胆固醇（LDL-c，基线112.8±54.9mg/dl降至94.5±67.4mg/dl）方面更有效。
治疗1年后，在降低轻度OSA患者的总胆固醇和LDL-c方面，CPAP优于MAD。
