Obstructive Sleep Apnea: Obesity, Sleep Apnea and Hypertension Linked

Julio A. Chirinos, MD, PhD Assistant Professor of Medicine Director, CTRC Cardiovascular Phenotyping Unit Perelman School of Medicine, University of Pennsylvania Director of Non-Invasive Imaging Philadelphia VA Medical CenterMedicalResearch.com Interview with:
Julio A. Chirinos, MD, PhD
Assistant Professor of Medicine
Director, CTRC Cardiovascular Phenotyping Unit
Perelman School of Medicine, University of Pennsylvania
Director of Non-Invasive Imaging
Philadelphia VA Medical Center

MedicalResearch: What are the main findings of the study?

Dr. Chirinos: The main findings of the study is that, among patients with obesity and moderate to severe obstructive sleep apnea, obesity, rather than OSA, appears to be the primary cause of inflammation, insulin resistance and dyslipidemia. However, both obesity and obstructive sleep apnea appear to be causally related to hypertension. In this population, weight loss, but not CPAP, can be expected to reduce the burden of inflammation, insulin resistance and dyslipidemia. However, CPAP, among patients who comply with therapy, can be expected to provide a significant incremental benefit on blood pressure. The latter is an important potential benefit of CPAP and should not be disregarded.

MedicalResearch: Were any of the findings unexpected?

Dr. Chirinos: The lack of an effect of CPAP on inflammation, insulin resistance and atherogenic dyslipidemia was, to some degree, unexpected, since previous observational studies had suggested that CPAP does have an effect on these risk factors. However, this was a randomized trial, which provides more definitive evidence than previous observational studies.

MedicalResearch: What should clinicians and patients take away from your report?

Dr. Chirinos: The main message is that weight loss should be the essential component of CV risk factor reduction in this population. 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.

MedicalResearch: What recommendations do you have for future research as a result of this study?

Dr. Chirinos: 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, we need more research on strategies to enhance CPAP adherence and to identify, a priori, patients who are most likely to demonstrate an important reduction in blood pressure with CPAP.

Citation:
CPAP, Weight Loss, or Both for Obstructive Sleep Apnea

Julio A. Chirinos, M.D., Ph.D., Indira Gurubhagavatula, M.D., Karen Teff, Ph.D., Daniel J. Rader, M.D., Thomas A. Wadden, Ph.D., Raymond Townsend, M.D., Gary D. Foster, Ph.D., Greg Maislin, M.S., M.A., Hassam Saif, M.D., Preston Broderick, M.A., Jesse Chittams, M.S., Alexandra L. Hanlon, Ph.D., and Allan I. Pack, M.B., Ch.B., Ph.D.

N Engl J Med 2014; 370:2265-2275June 12, 2014DOI: 10.1056/NEJMoa1306187

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