Effects of CPAP on visceral adipose tissue in patients with obstructive sleep apnea: a meta-analysis

Abstract

Purpose

The efficacy of obstructive sleep apnea (OSA) treatment with continuous positive airway pressure (CPAP) on visceral adipose tissue (VAT) yielded conflicting results. This meta-analysis was performed to assess whether OSA treatment with CPAP could reduce VAT.

Methods

The PubMed, Cochrane Library, Embase, and Web of Science were searched before April 2019. Information on characteristics of study participants, pre- and post-CPAP treatment of VAT, and study design was utilized for analysis. Standardized mean difference (SMD) and 95% confidence interval (CI) were used to fully analyze the overall effects. Eleven studies were obtained and the meta-analysis was performed using RevMan v.5.2 and STATA 12.0.

Results

A total of 11 studies (16 cohorts) were pooled into meta-analysis, which included 398 patients. The value of VAT before and after CPAP treatment showed no change in OSA patients (SMD = − 0.02, 95% CI − 0.16 to 0.12, z = 0.24, p = 0.81). Subgroup analyses were further conducted, which revealed that age, gender distribution, baseline body mass index, daily duration, CPAP therapy duration, measure, sample size, and study design did not affect the results.

Conclusions

This meta-analysis revealed that CPAP therapy has no effect on VAT in OSA patients. Further large-scale, well-designed randomized controlled trials are required to address this issue.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

References

  1. 1.

    Lindberg E, Gislason T (2000) Epidemiology of sleep-related obstructive breathing. Sleep Med Rev 4:411–433. https://doi.org/10.1053/smrv.2000.0118

    CAS  Article  PubMed  Google Scholar 

  2. 2.

    Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S (1993) The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 328:1230–1235. https://doi.org/10.1056/NEJM199304293281704

    CAS  Article  PubMed  Google Scholar 

  3. 3.

    Shpilsky D, Erqou S, Patel SR, Kip KE, Ajala O, Aiyer A, Strollo PJ, Reis SE, Olafiranye O (2018) Association of obstructive sleep apnea with microvascular endothelial dysfunction and subclinical coronary artery disease in a community-based population. Vasc Med 23:331–339. https://doi.org/10.1177/1358863X18755003

    CAS  Article  PubMed  Google Scholar 

  4. 4.

    Calhoun DA (2010) Obstructive sleep apnea and hypertension. Curr Hypertens Rep 12:189–195. https://doi.org/10.1007/s11906-010-0112-8

    Article  PubMed  Google Scholar 

  5. 5.

    McNicholas WT, Bonsigore MR (2007) Sleep apnoea as an independent risk factor for cardiovascular disease: current evidence, basic mechanisms and research priorities. Eur Respir J 29:156–178. https://doi.org/10.1183/09031936.00027406

    CAS  Article  PubMed  Google Scholar 

  6. 6.

    Buratti L, Luzzi S, Petrelli C, Baldinelli S, Viticchi G, Provinciali L, Altamura C, Vernieri F, Silvestrini M (2016) Obstructive sleep apnea syndrome: an emerging risk factor for dementia. CNS Neurol Disord Drug Targets 15:678–682

    CAS  Article  Google Scholar 

  7. 7.

    Schafer H, Pauleit D, Sudhop T, Gouni-Berthold I, Ewig S, Berthold HK (2002) Body fat distribution, serum leptin, and cardiovascular risk factors in men with obstructive sleep apnea. CHEST 122:829–839

    Article  Google Scholar 

  8. 8.

    de Lima FF, Mazzotti DR, Tufik S, Bittencourt L (2016) The role inflammatory response genes in obstructive sleep apnea syndrome: a review. Sleep Breath 20:331–338. https://doi.org/10.1007/s11325-015-1226-7

    Article  PubMed  Google Scholar 

  9. 9.

    Turnbull CD, Wang SH, Manuel AR, Keenan BT, McIntyre AG, Schwab RJ, Stradling JR (2018) Relationships between MRI fat distributions and sleep apnea and obesity hypoventilation syndrome in very obese patients. Sleep Breath 22:673–681. https://doi.org/10.1007/s11325-017-1599-x

    CAS  Article  PubMed  Google Scholar 

  10. 10.

    Romero-Corral A, Caples SM, Lopez-Jimenez F, Somers VK (2010) Interactions between obesity and obstructive sleep apnea: implications for treatment. CHEST 137:711–719. https://doi.org/10.1378/chest.09-0360

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  11. 11.

    Ogretmenoglu O, Suslu AE, Yucel OT, Onerci TM, Sahin A (2005) Body fat composition: a predictive factor for obstructive sleep apnea. LARYNGOSCOPE 115:1493–1498. https://doi.org/10.1097/01.mlg.0000172204.82314.c3

    Article  PubMed  Google Scholar 

  12. 12.

    Vgontzas AN, Papanicolaou DA, Bixler EO, Hopper K, Lotsikas A, Lin HM, Kales A, Chrousos GP (2000) Sleep apnea and daytime sleepiness and fatigue: relation to visceral obesity, insulin resistance, and hypercytokinemia. J Clin Endocrinol Metab 85:1151–1158. https://doi.org/10.1210/jcem.85.3.6484

    CAS  Article  PubMed  Google Scholar 

  13. 13.

    Palm A, Midgren B, Theorell-Haglow J, Ekstrom M, Ljunggren M, Janson C, Lindberg E (2018) Factors influencing adherence to continuous positive airway pressure treatment in obstructive sleep apnea and mortality associated with treatment failure - a national registry-based cohort study. Sleep Med 51:85–91. https://doi.org/10.1016/j.sleep.2018.07.007

    Article  PubMed  Google Scholar 

  14. 14.

    Myllyla M, Hammais A, Stepanov M, Anttalainen U, Saaresranta T, Laitinen T (2019) Nonfatal and fatal cardiovascular disease events in CPAP compliant obstructive sleep apnea patients. SLEEP BREATH. https://doi.org/10.1007/s11325-019-01808-4

  15. 15.

    Trenell MI, Ward JA, Yee BJ, Phillips CL, Kemp GJ, Grunstein RR, Thompson CH (2007) Influence of constant positive airway pressure therapy on lipid storage, muscle metabolism and insulin action in obese patients with severe obstructive sleep apnoea syndrome. Diabetes Obes Metab 9:679–687. https://doi.org/10.1111/j.1463-1326.2006.00649.x

    CAS  Article  PubMed  Google Scholar 

  16. 16.

    Chin K, Shimizu K, Nakamura T, Narai N, Masuzaki H, Ogawa Y, Mishima M, Nakamura T, Nakao K, Ohi M (1999) Changes in intra-abdominal visceral fat and serum leptin levels in patients with obstructive sleep apnea syndrome following nasal continuous positive airway pressure therapy. CIRCULATION 100:706–712

    CAS  Article  Google Scholar 

  17. 17.

    Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 339:b2535. https://doi.org/10.1136/bmj.b2535

    Article  PubMed  PubMed Central  Google Scholar 

  18. 18.

    Vgontzas AN, Zoumakis E, Bixler EO, Lin HM, Collins B, Basta M, Pejovic S, Chrousos GP (2008) Selective effects of CPAP on sleep apnoea-associated manifestations. Eur J Clin Investig 38:585–595. https://doi.org/10.1111/j.1365-2362.2008.01984.x

    CAS  Article  Google Scholar 

  19. 19.

    Munzer T, Hegglin A, Stannek T, Schoch OD, Korte W, Buche D, Schmid C, Hurny C (2010) Effects of long-term continuous positive airway pressure on body composition and IGF1. Eur J Endocrinol 162:695–704. https://doi.org/10.1530/EJE-09-0919

    CAS  Article  PubMed  Google Scholar 

  20. 20.

    Makino S, Fujiwara M, Handa H, Fujie T, Aoki Y, Hashimoto K, Terada Y, Sugimoto T (2012) Plasma dehydroepiandrosterone sulphate and insulin-like growth factor I levels in obstructive sleep apnoea syndrome. Clin Endocrinol 76:593–601. https://doi.org/10.1111/j.1365-2265.2011.04237.x

    CAS  Article  Google Scholar 

  21. 21.

    Kostopoulos K, Alhanatis E, Pampoukas K, Georgiopoulos G, Zourla A, Panoutsopoulos A, Kallianos A, Velentza L, Zarogoulidis P, Trakada G (2016) CPAP therapy induces favorable short-term changes in epicardial fat thickness and vascular and metabolic markers in apparently healthy subjects with obstructive sleep apnea-hypopnea syndrome (OSAHS). Sleep Breath 20:483–493. https://doi.org/10.1007/s11325-015-1236-5

    Article  PubMed  Google Scholar 

  22. 22.

    Kritikou I, Basta M, Tappouni R, Pejovic S, Fernandez-Mendoza J, Nazir R, Shaffer ML, Liao D, Bixler EO, Chrousos GP, Vgontzas AN (2013) Sleep apnoea and visceral adiposity in middle-aged male and female subjects. Eur Respir J 41:601–609. https://doi.org/10.1183/09031936.00183411

    CAS  Article  PubMed  Google Scholar 

  23. 23.

    Lin G, Chen Q, Huang J, Chen L, Lin T, Lin Q (2018) Effect of continuous positive airway pressure on endothelin-1 in patients with obstructive sleep apnea: a meta-analysis. Eur Arch Otorhinolaryngol 276:623–630. https://doi.org/10.1007/s00405-018-5225-8

    Article  PubMed  Google Scholar 

  24. 24.

    Qi JC, Zhang L, Li H, Zeng H, Ye Y, Wang T, Wu Q, Chen L, Xu Q, Zheng Y, Huang Y, Lin L (2018) Impact of continuous positive airway pressure on vascular endothelial growth factor in patients with obstructive sleep apnea: a meta-analysis. SLEEP BREATH 23:5–12. https://doi.org/10.1007/s11325-018-1660-4

    Article  PubMed  Google Scholar 

  25. 25.

    Ping Z, Pei X, Xia P, Chen Y, Guo R, Hu C, Imam MU, Chen Y, Sun P, Liu L (2018) Anthropometric indices as surrogates for estimating abdominal visceral and subcutaneous adipose tissue: a meta-analysis with 16,129 participants. Diabetes Res Clin Pract 143:310–319. https://doi.org/10.1016/j.diabres.2018.08.005

    Article  PubMed  Google Scholar 

  26. 26.

    Vgontzas AN, Bixler EO, Chrousos GP (2003) Metabolic disturbances in obesity versus sleep apnoea: the importance of visceral obesity and insulin resistance. J Intern Med 254:32–44

    CAS  Article  Google Scholar 

  27. 27.

    Ryan S (2017) Adipose tissue inflammation by intermittent hypoxia: mechanistic link between obstructive sleep apnoea and metabolic dysfunction. J Physiol 595:2423–2430. https://doi.org/10.1113/JP273312

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  28. 28.

    Canapari CA, Hoppin AG, Kinane TB, Thomas BJ, Torriani M, Katz ES (2011) Relationship between sleep apnea, fat distribution, and insulin resistance in obese children. J Clin Sleep Med 7:268–273. https://doi.org/10.5664/JCSM.1068

    Article  PubMed  PubMed Central  Google Scholar 

  29. 29.

    Lam DC, Xu A, Lam KS, Lam B, Lam JC, Lui MM, Ip MS (2009) Serum adipocyte-fatty acid binding protein level is elevated in severe OSA and correlates with insulin resistance. Eur Respir J 33:346–351. https://doi.org/10.1183/09031936.50075408

    CAS  Article  PubMed  Google Scholar 

  30. 30.

    Trakada G, Chrousos G, Pejovic S, Vgontzas A (2007) Sleep apnea and its association with the stress system, inflammation, insulin resistance and visceral obesity. Sleep Med Clin 2:251–261. https://doi.org/10.1016/j.jsmc.2007.04.003

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  31. 31.

    Yokoe T, Minoguchi K, Matsuo H, Oda N, Minoguchi H, Yoshino G, Hirano T, Adachi M (2003) Elevated levels of C-reactive protein and interleukin-6 in patients with obstructive sleep apnea syndrome are decreased by nasal continuous positive airway pressure. CIRCULATION 107:1129–1134

    CAS  Article  Google Scholar 

  32. 32.

    Liu KH, Chu WC, To KW, Ko FW, Ng SS, Ngai JC, Chan JW, Ahuja AT, Hui DS (2014) Mesenteric fat thickness is associated with increased risk of obstructive sleep apnoea. RESPIROLOGY 19:92–97. https://doi.org/10.1111/resp.12164

    Article  PubMed  Google Scholar 

  33. 33.

    Hunter GR, Gower BA, Kane BL (2010) Age related shift in visceral fat. Int J Body Compos Res 8:103–108

    PubMed  PubMed Central  Google Scholar 

Download references

Funding

This study was funded by the Chinese National Natural Science Foundation (grant number 81870074); Science and Technology Projects of Quanzhou (grant numbers 2018N007S and Z【2014】0127); Science and Technology Project of Fujian Education Department (grant number JT180199), and Startup Fund for Scientific Research, Fujian Medical University (grant number: 2017XQ1102).

Author information

Affiliations

Authors

Contributions

All authors directly participated in the study and have reviewed and approved the final manuscript.

Corresponding author

Correspondence to Qichang Lin.

Ethics declarations

This article does not contain any studies with human participants performed by any of the authors.

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Chen, Q., Lin, G., Huang, J. et al. Effects of CPAP on visceral adipose tissue in patients with obstructive sleep apnea: a meta-analysis. Sleep Breath 24, 425–432 (2020). https://doi.org/10.1007/s11325-019-01932-1

Download citation

Keywords

  • Obstructive sleep apnea
  • Continuous positive airway pressure
  • Visceral adipose tissue
  • Meta-analysis