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From the author:

P. Lévy
European Respiratory Journal 2009 34: 1210-1211; DOI: 10.1183/09031936.00111109
P. Lévy
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In response to our recent article on sleep, sleep-disordered breathing and metabolism 1, P. Steiropoulos and co-workers wish to emphasise the role of adherence to continuous positive airway pressure (CPAP) treatment in improving obstructive sleep apnoea (OSA) metabolic status. This is certainly a major factor of success regarding CPAP treatment effectiveness. Whilst CPAP compliance remains a major challenge 2, the optimal duration of treatment remains unclear. It has been suggested that improving vigilance and cognitive function would need a minimum of 5 h, apparently with additional benefits when the duration of treatment was further increased 3. This is much less clear as regard cardiovascular and metabolic changes. There is apparently a relationship between CPAP duration and reduction in blood pressure 4. There is very limited evidence regarding CPAP effects on glycaemic control. P. Steiropoulos and co-workers noticed that mean CPAP use in the two randomised control trials was <4 h, 3.6 5 and 3.9 h 6, respectively. Thus, they question whether insufficient CPAP use may be a potential confounding factor in the published negative findings. They have recently demonstrated that CPAP use for >4 h per night is crucial in ameliorating HbA1c and total cholesterol levels along with several inflammation markers after 6 months of CPAP treatment in non-diabetic OSA patients, with only adherent patients exhibiting beneficial metabolic effect 7. They also recently reported that only patients using CPAP for >4 h had significant reduction in soluble and cellular immune response factors 8. Their study on glycaemic control 7 is not a randomised controlled trial and as such has significant limitations. Moreover, good adherence to long-term CPAP treatment seems to significantly reduce HbA1C levels but has no effect on markers of insulin resistance 7. The study by Harsch et al. 9 did not shown any effect on insulin sensitivity in OSA patients with a body mass index >30 kg·m−2. In this study, the mean compliance to CPAP was high, i.e. 5.2±0.91 h 9. In addition, there was no association between mean duration of CPAP use per night and change in insulin sensitivity from baseline to 3 months 9. Insulin resistance and glycaemia are closely linked in obesity and diabetes pathophysiology. Thus, it may be concluded that CPAP compliance is certainly an important issue. However, obesity is a major confounding factor in OSA. Thus, it is not surprising that CPAP effects on glycaemic control could be modulated by the degree of obesity. It should certainly be further studied by large randomised controlled trials 10, 11.

Statement of interest

None declared.

    • © ERS Journals Ltd

    References

    1. ↵
      Lévy P, Bonsignore MR, Eckel J. Sleep, sleep-disordered breathing and metabolic consequences. Eur Respir J 2009;34:243–260.
      OpenUrlAbstract/FREE Full Text
    2. ↵
      Pepin JL, Krieger J, Rodenstein D, et al. Effective compliance during the first 3 months of continuous positive airway pressure. A European prospective study of 121 patients. Am J Respir Crit Care Med 1999;160:1124–1129.
      OpenUrlCrossRefPubMedWeb of Science
    3. ↵
      Weaver TE, Maislin G, Dinges DF, et al. Relationship between hours of CPAP use and achieving normal levels of sleepiness and daily functioning. Sleep 2007;30:711–719.
      OpenUrlPubMedWeb of Science
    4. ↵
      Haentjens P, Van Meerhaeghe A, Moscariello A, et al. The impact of continuous positive airway pressure on blood pressure in patients with obstructive sleep apnea syndrome: evidence from a meta-analysis of placebo-controlled randomized trials. Arch Intern Med 2007;167:757–764.
      OpenUrlCrossRefPubMedWeb of Science
    5. ↵
      West SD, Nicoll DJ, Wallace TM, et al. Effect of CPAP on insulin resistance and HbA1c in men with obstructive sleep apnoea and type 2 diabetes. Thorax 2007;62:969–974.
      OpenUrlAbstract/FREE Full Text
    6. ↵
      Coughlin SR, Mawdsley L, Mugarza JA, et al. Cardiovascular and metabolic effects of CPAP in obese males with OSA. Eur Respir J 2007;29:720–727.
      OpenUrlAbstract/FREE Full Text
    7. ↵
      Steiropoulos P, Papanas N, Nena E, et al. Markers of glycemic control and insulin resistance in non-diabetic patients with obstructive sleep apnea hypopnea syndrome: does adherence to CPAP treatment improve glycemic control? Sleep Med 2009;8:887–891.
      OpenUrl
    8. ↵
      Steiropoulos P, Kotsianidis I, Nena E, et al. Long-term effect of continuous positive airway pressure therapy on inflammation markers of patients with obstructive sleep apnea syndrome. Sleep 2009;32:537–543.
      OpenUrlPubMedWeb of Science
    9. ↵
      Harsch IA, Schahin SP, Radespiel-Troger M, et al. Continuous positive airway pressure treatment rapidly improves insulin sensitivity in patients with obstructive sleep apnea syndrome. Am J Respir Crit Care Med 2004;169:156–162.
      OpenUrlCrossRefPubMedWeb of Science
    10. ↵
      Shaw JE, Punjabi NM, Wilding JP, et al. Sleep-disordered breathing and type 2 diabetes: a report from the International Diabetes Federation Taskforce on Epidemiology and Prevention. Diabetes Res Clin Pract 2008;81:2–12.
      OpenUrlCrossRefPubMedWeb of Science
    11. ↵
      Tasali E, Mokhlesi B, Van Cauter E. Obstructive sleep apnea and type 2 diabetes: interacting epidemics. Chest 2008;133:496–506.
      OpenUrlCrossRefPubMedWeb of Science
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    European Respiratory Journal Nov 2009, 34 (5) 1210-1211; DOI: 10.1183/09031936.00111109

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    European Respiratory Journal Nov 2009, 34 (5) 1210-1211; DOI: 10.1183/09031936.00111109
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