Weight loss critical to reducing cardiovascular risk in obese OSA patients

June 11, 2014

Obesity and obstructive sleep apnea (OSA) tend to co-exist and are associated with a variety of cardiovascular risk factors, including inflammation, insulin resistance, abnormal cholesterol, and high blood pressure. While effective therapies are available for OSA, researchers are still unclear about what interventions are most effective in reducing the burden of risk factors for cardiovascular disease associated with OSA in obese patients. New research from a multidisciplinary team at the Perelman School of Medicine at the University of Pennsylvania now reveals that the single most important factor for improving cardiovascular health in obese OSA patients is weight loss. The study results will be published in the New England Journal of Medicine.

"In the U.S. almost 1 in 5 adults has sleep apnea, which is associated with an increased risk for a variety of cardiovascular complications. Sleep apnea and obesity are strongly associated. We performed this study to find out to what degree obesity and OSA contribute to the burden of and to quantify the reduction in these risk factors achieved by , therapy for sleep apnea, or the combination of both" said lead study author Julio Chirinos, MD, PhD, assistant professor of Medicine at Penn.

In the trial, the investigators randomly assigned 181 participants with obesity, moderate-to-severe and high C-reactive protein levels (CRP) (an inflammatory marker associated with heart disease) for 24 weeks to either weight loss therapy, CPAP therapy, or the combination of weight loss and CPAP. The authors then evaluated the incremental effect of combination therapy with CPAP and weight loss over each therapy alone, on subclinical inflammation, , dyslipidemia and blood pressure in obese subjects with OSA.

They found no significant effect of combination therapy over either therapy alone when it came to reducing CRP levels. Weight loss alone significantly reduced CRP, insulin resistance, dyslipidemia and . In stark contrast, they did not observe a significant effect of CPAP on CRP, insulin sensitivity or dyslipidemia, even among subjects who adhered to therapy. "These data argue against an independent causal relationship between obstructive sleep apnea and these cardiovascular risk factors in this population and suggest that CPAP is not an effective therapy to reduce the burden of these particular risk factors. These findings also indicate that weight loss therapy should be a central component of strategies to improve the cardiovascular risk factor profile of obese patients with OSA," said Chirinos.

Despite the lack of an effect of CPAP therapy on the mentioned above, both CPAP and weight loss reduced blood pressure. Furthermore, among subjects who adhered to therapy, CPAP provided an incremental effect over weight loss-only (i.e., participants randomized to combination therapy had a more pronounced effect on blood pressure than participants receiving either therapy alone). "The design of this trial allowed us to conclude that both obesity and are causally related to high blood pressure," Chirinos added.

In addition, the results suggest that adhering to a regimen of weight loss and CPAP therapy will result in larger reductions in blood pressure as compared with either therapy alone.

The study opens several questions for future research. "Effective weight reduction interventions as applied in our study are costly and require a multidisciplinary team with expertise in weight loss. Future research should assess how to best deliver effective weight loss programs for these patients. In addition, more research on strategies to enhance CPAP adherence or to identify subjects that are most likely to demonstrate an important reduction in with CPAP would be desirable," said Chirinos.

Explore further: CPAP rapidly improves blood pressure and arterial tone in adults with sleep apnea

Related Stories

CPAP rapidly improves blood pressure and arterial tone in adults with sleep apnea

June 2, 2014
A new study suggests that continuous positive airway pressure (CPAP) therapy rapidly improves blood pressure and arterial tone in adults with obstructive sleep apnea (OSA).

Family support may improve adherence to CPAP therapy for sleep apnea

May 29, 2014
A new study suggests that people with obstructive sleep apnea (OSA) who are single or have unsupportive family relationships may be less likely to adhere to continuous positive airway pressure (CPAP) therapy.

American College of Physicians releases new recommendations for treating obstructive sleep apnea

September 23, 2013
People diagnosed with obstructive sleep apnea (OSA) should lose weight and use continuous positive airway pressure (CPAP) as initial therapy, according to new recommendations from the American College of Physicians (ACP) ...

Use of CPAP for sleep apnea reduces blood pressure for patients with difficult to treat hypertension

December 10, 2013
Among patients with obstructive sleep apnea and hypertension that requires 3 or more medications to control, continuous positive airway pressure (CPAP) treatment for 12 weeks resulted in a decrease in 24-hour average and ...

CPAP reduces risk of death in people with COPD and sleep apnea

August 14, 2013
A new study suggests that continuous positive airway pressure (CPAP) therapy reduces the mortality rate in people who have both chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA), which the authors ...

A little weight loss may ease sleep apnea

February 21, 2014
(HealthDay)—A small amount of weight loss might help combat sleep apnea, a new study suggests.

Recommended for you

Anti-nausea drug could help treat sleep apnea

June 6, 2017
An old pharmaceutical product may be a new treatment for obstructive sleep apnea, according to new research presented today by University of Illinois at Chicago and Northwestern University scientists at the SLEEP 2017 annual ...

New disposable, wearable patch found to effectively detect sleep apnea

June 4, 2017
Results of a definitive clinical trial show that a new, disposable diagnostic patch effectively detects obstructive sleep apnea across all severity levels.

Childhood sleep apnoea is common but hard to diagnose

April 28, 2017
The cessation of breathing during sleep caused by enlarged tonsils is common in preschool-age children and can cause serious complications, but the methods normally used to diagnose the condition are subjective and unreliable. ...

Curbing sleep apnea might mean fewer night trips to bathroom

March 27, 2017
(HealthDay)—Millions of Americans battle bothersome nighttime conditions, such as sleep apnea or the need to get up frequently to urinate.

Untreated sleep apnea in children can harm brain cells tied to cognition and mood

March 17, 2017
A study comparing children between 7 and 11 years of age who have moderate or severe obstructive sleep apnea to children the same age who slept normally, found significant reductions of gray matter - brain cells involved ...

Dietary supplement derived from tree bark shows promise for treating obstructive sleep apnea

February 24, 2017
Obstructive sleep apnea, which causes people to briefly stop breathing while asleep, affects an estimated 5 percent of the population, not including the many more who don't even realize they suffer from the disorder.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.