Department of Medicine, University of Verona, Section of General Medicine and Hypertension, Verona, Italy.
IRCCS, Istituto Auxologico Italiano, Department of Cardiovascular, Neural and Metabolic Sciences, S. Luca Hospital, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
Arch Bronconeumol. 2023 Jun;59(6):370-376. doi: 10.1016/j.arbres.2023.03.012. Epub 2023 Mar 21.
Continuous Positive Airway Pressure (CPAP) is the most effective therapy for symptomatic obstructive sleep apnoea (OSA). However, uncertainty remains about the effectiveness of CPAP in improving OSA-related metabolic dysregulation. This meta-analysis of randomized controlled trials (RCTs) aimed to investigate whether CPAP, compared to other control treatments, could improve glucose or lipid metabolism in OSA patients.
Relevant articles were searched in three different databases (MEDLINE, EMBASE and Web of Science) from inception to 6th Feb 2022 through specific search terms and selection criteria.
From a total of 5553 articles, 31 RCTs were included. CPAP modestly improved insulin sensitivity as determined by mean fasting plasma insulin and Homeostasis Model Assessment of Insulin Resistance reduction of 1.33mU/L and 0.287, respectively. In subgroup analyses pre-diabetic/type 2 diabetic patients as well as those with sleepy OSA showed a greater response to CPAP. Regarding lipid metabolism, CPAP was associated with a mean total cholesterol reduction of 0.064mmol/L. In subgroup analyses, the benefit was higher in patients that showed more severe OSA and oxygen desaturations at the baseline sleep study as well as in younger and obese subjects. Neither glycated haemoglobin nor triglycerides, HDL- and LDL-cholesterol were reduced by CPAP.
CPAP treatment may improve insulin sensitivity and total cholesterol levels in OSA patients but with low effect size. Our results suggest that CPAP does not substantially improve metabolic derangements in an unselected OSA population, but the effect may be higher in specific subgroups of OSA patients.
持续气道正压通气（CPAP）是治疗症状性阻塞性睡眠呼吸暂停（OSA）最有效的方法。然而，CPAP 在改善 OSA 相关代谢紊乱方面的有效性仍存在不确定性。本项随机对照试验（RCT）的荟萃分析旨在研究 CPAP 是否比其他对照治疗更能改善 OSA 患者的葡萄糖或脂质代谢。
通过特定的搜索词和选择标准，从三个不同的数据库（MEDLINE、EMBASE 和 Web of Science）中搜索了从开始到 2022 年 2 月 6 日的相关文章。
从总共 5553 篇文章中，纳入了 31 项 RCT。CPAP 可适度改善胰岛素敏感性，表现为平均空腹血浆胰岛素和稳态模型评估的胰岛素抵抗分别降低 1.33mU/L 和 0.287。亚组分析显示，对于糖尿病前期/2 型糖尿病患者和嗜睡性 OSA 患者，CPAP 的反应更大。关于脂质代谢，CPAP 与平均总胆固醇降低 0.064mmol/L 相关。在亚组分析中，基线睡眠研究中 OSA 更严重和氧饱和度下降的患者以及年轻和肥胖的患者获益更高。CPAP 并未降低糖化血红蛋白或甘油三酯、HDL-和 LDL-胆固醇。
CPAP 治疗可能改善 OSA 患者的胰岛素敏感性和总胆固醇水平，但作用幅度较小。我们的结果表明，CPAP 并不能显著改善未选择的 OSA 人群的代谢紊乱，但在 OSA 患者的特定亚组中，效果可能更高。
