Efecto del tratamiento con presión positiva contínua en la vía aérea (CPAP) sobre distintos factores de riesgo vascular y marcadores de función endotelial y daño celular en pacientes con síndrome de apnea-hipopnea obstructiva del sueño

Resumen

Introduction: Obstructive sleep apnea-hypopnea syndrome (OSA) leads to repetitive episodes of hypoxemia-reoxygenation and changes in intrathoracic pressure that may result in sympathetic nervous system activation, oxidative stress, low-grade inflammation and endothelial dysfunction, among others. This may ultimately lead to vascular injury and development of atherosclerotic lesions. In fact, OSA has been consistently related to both prevalent and incident cardiovascular disease. By preventing the episodes of apneas and hipopneas, the treatment with CPAP could ameliorate or even revert the underlying altered pathophysiologic mechanisms that are present in patients with OSA and, as a result, reduce the vascular risk that this disease may pose on these individuals. Objectives: To assess, in patients with moderate to severe OSA, the effect of treatment with CPAP on different markers of endothelial function and cell damage, as well as on other vascular risk-related conditions such as blood pressure, insulin resistance and lipid levels, C-reactive protein (CRP) and markers of fibrosis. As a secondary aim, we also intended to evaluate whether the presence of a diagnosis of hypertension may influence the effect that the CPAP therapy may have on the aforementioned markers and conditions. Conclusions: In moderate to severe OSA patients the treatment with CPAP, by preventing the episodes of apneas and hipopneas, may improve the vascular risk of such individuals by promoting a reduction in blood pressure and an improvement of the endothelial function and insulin resistance. The effect of the CPAP therapy in each case could be influenced by the OSA severity and the presence of hypertension (even when this condition is well-controlled).