Continuous positive airway pressure may reverse metabolic syndrome

Obstructive sleep apnoea (OSA) treatment with continuous positive airway pressure (CPAP) has the potential to resolve metabolic syndrome in adult patients, according to data from the TREATOSA-MS study.

TREATOSA-MS included 100 adults (mean age 48 years, 79 percent male, body mass index 33 kg/m²) with a recent diagnosis of metabolic syndrome and moderate-to-severe OSA (apnoea-hypopnea index, [AHI] ≥15 events/h). They were randomized to undergo therapeutic CPAP (n=50) or receive nasal strips (placebo group; n=50) for 6 months.

Researchers measured anthropometric variables, blood pressure, glucose, and lipid profile prior to and after each treatment session. They also evaluated adiposity biomarkers (leptin and adiponectin), body composition, food intake, physical activity, subcutaneous and abdominal fat (visceral and hepatic fat) and endothelial function to control for potential related mechanisms and consequences.

The mean CPAP adherence was 5.5±1.5 h/night. At treatment completion, metabolic syndrome remained in most patients with OSA who underwent CPAP. However, the rate of metabolic syndrome reversibility was much higher than that observed in the placebo group (18 percent vs 4 percent).

In multivariable logistic regression models, CPAP was associated with a fivefold higher likelihood of achieving metabolic syndrome reversal compared with placebo (odds ratio, 5.27, 95 percent confidence interval, 1.27–35.86; p=0.04).

Secondary analysis indicated that CPAP did not produce significant improvements in the individual components of metabolic syndrome, weight, hepatic steatosis, lipid profile, adiponectin, and leptin. Nevertheless, there was a modest reduction in visceral fat and improved endothelial function.

The finding regarding the lack of relevant effects on adiposity biomarkers and depots supports the modest utility of OSA for treating metabolic syndrome.