Appropriate Use of Nasal Continuous Positive Airway Pressure Decreases Elevated C-Reactive Protein in Patients With Obstructive Sleep Apnea

摘要

Background: C-reactive protein (CRP) is an important risk factor for cardiovascular disease.nFurthermore, it has been reported that levels of CRP are increased in patients with obstructivensleep apnea (OSA). The aim of this study was to examine the effects of long-term therapy withnnasal continuous positive airway pressure (nCPAP) on CRP levels and to investigate whetherncompliance with nCPAP therapy more effectively attenuated markers of systemic inflammation innpatients with OSA.nMethods and results: Fifty-five patients (mean [u0001 SEM] age, 55 u0001 2 years; 44 male patients, 11nfemale patients) with newly diagnosed moderate-to-severe OSA (apnea-hypopnea index > 20nevents/h) were studied before and after 6 months of nCPAP treatment. There was a significantnreduction in CRP levels after nCPAP therapy (before nCPAP therapy, 0.23 u0001 0.03 mg/dL; afternnCPAP therapy, 0.17 u0001 0.02 mg/dL; p < 0.01). Additionally, we divided these patients into twongroups based on adherence to nCPAP therapy. A group of patients using nCPAP > 4 h/d and > 5nd/wk were designated as the good compliance group. The decrease in CRP concentration wasnsignificant (before nCPAP therapy, 0.23 u0001 0.04 mg/dL; after nCPAP therapy, 0.16 u0001 0.03 mg/dL;np < 0.05) in the good compliance group but not in the poor compliance group (before nCPAPntherapy, 0.24 u0001 0.05 mg/dL; after nCPAP therapy, 0.20 u0001 0.05 mg/dL; p u0002 0.21). Furthermore,nwe divided those patients into a high CRP group (> 0.2 mg/dL) and a normal CRP group (< 0.2nmg/dL) before nCPAP therapy. The significant decrease in CRP levels in the good compliancengroup was evident only in those patients with an initially elevated CRP level (before nCPAPntherapy, 0.48 u0001 0.08 mg/dL; after nCPAP therapy, 0.29 u0001 0.06 mg/dL; p < 0.05).nConclusion: Appropriate use of nCPAP in patients with OSA may be required to decrease elevatednCRP levels, with possible implications for cardiovascular morbidity and mortality.