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The Impact of Continuous Positive Airway Pressure on Circulating IGF-1 in Patients With Obstructive Sleep Apnea
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical diabetology and metabolism.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy. (Fysioterapi)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy.ORCID iD: 0000-0002-7999-6087
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2018 (English)In: Journal of Clinical Sleep Medicine (JCSM), ISSN 1550-9389, E-ISSN 1550-9397, p. 385-391Article in journal (Refereed) Published
Abstract [en]

Study Objectives: Obstructive sleep apnea (OSA) is a disease with metabolic and cardiovascular consequences and is associated with decreased serum concentrations of insulin-like growth factor-1 (IGF-1). The aim of this study was to investigate whether continuous positive airway pressure (CPAP) will increase serum IGF-1 concentration in patients with OSA. Methods: Patients with moderate to severe OSA were recruited from a sleep clinic and serum IGF-1 was measured before initiation of CPAP and at follow-up after 4.8 +/- 2.5 months. Patients adherent to CPAP treatment (usage >= 4 h/night) were compared with those considered to be nonadherent (usage < 4 h/night). Results: Complete data were obtained from 69 patients (86% male, age 56 +/- 12 years, respiratory event index 43 +/- 21 events/h, Epworth Sleepiness Scale score 12 +/- 5). In those adherent to CPAP (n = 42), there was an increase in serum IGF-1 concentration with 21.1 (95% confidence interval [CI]: 13.1 to 29.2) mu g/L compared to 4.7 (95% CI: -4.1 to 13.5) mu g/L in the nonadherent group (n = 27) (P =.0083). In a linear multivariate model adjusting for sex, age, body mass index, respiratory event index, and mean oxygen saturation during the night recording, the change in serum IGF-1 concentration was significantly associated with adherence to CPAP treatment (adjusted beta coefficient: 21.8, 95% CI: 10.2 to 33.4) and inversely associated with change in body mass index (adjusted beta coefficient: -7.1, 95% CI: -11.3 to -3.0) and change in hemoglobin A1c (adjusted beta coefficient: -1.8, 95% CI: - 33 to -0.3). Conclusions: CPAP usage >= 4 h/night is associated with increased serum IGF-1 concentration in male patients with OSA.

Place, publisher, year, edition, pages
2018. p. 385-391
Keywords [en]
adherence, continuous positive airway pressure, IGF-1, obstructive sleep apnea
National Category
Respiratory Medicine and Allergy
Identifiers
URN: urn:nbn:se:uu:diva-343619DOI: 10.5664/jcsm.6982ISI: 000427477700011PubMedID: 29458693OAI: oai:DiVA.org:uu-343619DiVA, id: diva2:1186451
Funder
Swedish Research CouncilAvailable from: 2018-02-28 Created: 2018-02-28 Last updated: 2018-09-25
In thesis
1. Obesity, Sleep and Sleep-disordered Breathing
Open this publication in new window or tab >>Obesity, Sleep and Sleep-disordered Breathing
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Sleep problems are associated with impaired quality of life and daytime sleepiness. Obstructive sleep apnoea (OSA) and obesity hypoventilation syndrome (OHS), are associated with metabolic changes and an increased cardiovascular morbidity and mortality. The most preferred treatment of OSA and OHS is positive airway pressure (PAP) therapy. Diagnostic delay and non-adherence to PAP therapy are major clinical problems.

Aims and methods: Paper I: A longitudinal population-based cohort study aimed to investigate the role of obesity and weight gain in the development of sleep problems in 1,896 men and 5,116 women who responded to questionnaires at baseline and followed up after 10–13 years.

Paper II: A national registry-based cohort study aimed to analyse gender differences in patients with OHS starting long term mechanical ventilation (LTMV) and to study how the prescription of LTMV due to OHS has changed over time with data on 1,527 patients derived from the Swedish quality registry Swedevox between 1996 and 2014.

Paper III: A longitudinal observational cohort study aimed to investigate the impact of adherence to continuous positive airway pressure (CPAP) treatment on IGF-1 concentration in 69 patients with OSA followed up after 4.8 ± 2.5 months.

Paper IV: A national registry-based cohort study aimed to identify protective and risk factors against the discontinuation of CPAP treatment in patients with OSA and to estimate the mortality risk in those who were non-adherent to CPAP therapy on 16,425 patients derived from the Swedish quality registry Swedevox between July 2010 and March 2017.

Results and conclusions: Weight gain is a risk factor for developing several sleep problems and daytime sleepiness. Women with OHS are older with a more advanced clinical picture at initiation of LTMV and start LTMV more frequently in a non-elective situation than men. CPAP usage ≥ 4 h/night is associated with increased IGF-1 concentration in patients with OSA. Use of humidifier, increasing age, more severe OSA and BMI up to 35 are associated with greater adherence to CPAP treatment. Female gender and coexisting hypertension are risk factors for the discontinuation of CPAP. Failure to adhere to CPAP is associated with increased mortality.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2018. p. 94
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1496
Keywords
Sleep, Obesity, Obstructive Sleep Apnea, Obesity Hypoventilation syndrome
National Category
Respiratory Medicine and Allergy
Research subject
Medical Science
Identifiers
urn:nbn:se:uu:diva-361345 (URN)978-91-513-0453-3 (ISBN)
Public defence
2018-11-09, Brömssalen, Gävle sjukhus, Lasarettsvägen 1, Gävle, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2018-10-17 Created: 2018-09-23 Last updated: 2018-11-19

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Palm, AndreasBerne, ChristianIgelström, HelenaÅsenlöf, PernillaJanson, ChristerLindberg, Eva

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