The Effects of Long-term CPAP on Weight Change in Patients With Comorbid OSA and Cardiovascular Disease

Data From the SAVE Trial
Published:September 27, 2018DOI:https://doi.org/10.1016/j.chest.2018.08.1082

      Background

      Although recent evidence suggests that OSA treatment may cause weight gain, the long-term effects of CPAP on weight are not well established.

      Methods

      This study was a post hoc analysis of the Sleep Apnea Cardiovascular Endpoints (SAVE) study, a multicenter, randomized trial of CPAP plus standard care vs standard care alone in adults with a history of cardiac or cerebrovascular events and moderate to severe OSA. Participants with weight, BMI, and neck and waist circumferences measured at baseline and during follow-up were included. Linear mixed models were used to examine sex-specific temporal differences, and a sensitivity analysis compared high CPAP adherers (≥ 4 h per night) with propensity-matched control participants.

      Results

      A total of 2,483 adults (1,248 in the CPAP group and 1,235 in the control group) were included (mean 6.1 ± 1.5 measures of weight available). After a mean follow-up of 3.78 years, there was no difference in weight change between the CPAP and control groups, for male subjects (mean [95% CI] between-group difference, 0.07 kg [–0.40 to 0.54]; P = .773) or female subjects (mean [95% CI] between-group difference, –0.14 kg [–0.37 to 0.09]; P = .233). Similarly, there were no significant differences in BMI or other anthropometric measures. Although male participants who used CPAP ≥ 4 h per night gained slightly more weight than matched male control subjects without CPAP (mean difference, 0.38 kg [95% CI, 0.04 to 0.73]; P = .031), there were no between-group differences in other anthropometric variables, nor were there any differences between female high CPAP adherers and matched control subjects.

      Conclusions

      Long-term CPAP use in patients with comorbid OSA and cardiovascular disease does not result in clinically significant weight change.

      Trial Registry

      ClinicalTrials.gov; No.: NCT00738179; URL: www.clinicaltrials.gov.

      Key Words

      Abbreviations:

      AHI ( apnea-hypopnea index), CV ( cardiovascular), ESS ( Epworth Sleepiness Scale), ODI ( oxygen desaturation index)
      To read this article in full you will need to make a payment
      Subscribe to CHEST
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Genta P.R.
        • Schorr F.
        • Eckert D.J.
        • et al.
        Upper airway collapsibility is associated with obesity and hyoid position.
        Sleep. 2014; 37: 1673-1678
        • Ryan S.
        • Crinion S.J.
        • McNicholas W.T.
        Obesity and sleep-disordered breathing—when two 'bad guys' meet.
        QJM. 2014; 107: 949-954
        • Wheatley J.R.
        • Mezzanotte W.S.
        • Tangel D.J.
        • White D.P.
        Influence of sleep on genioglossus muscle activation by negative pressure in normal men.
        Am Rev Respir Dis. 1993; 148: 597-605
        • Shechter A.
        Obstructive sleep apnea and energy balance regulation: a systematic review.
        Sleep Med Rev. 2017; 34: 59-69
        • Harsch I.A.
        • Konturek P.C.
        • Koebnick C.
        • et al.
        Leptin and ghrelin levels in patients with obstructive sleep apnoea: effect of CPAP treatment.
        Eur Respir J. 2003; 22: 251-257
        • Cao Y.
        • Wittert G.
        • Taylor A.W.
        • Adams R.
        • Shi Z.
        Associations between macronutrient intake and obstructive sleep apnoea as well as self-reported sleep symptoms: results from a cohort of community dwelling Australian men.
        Nutrients. 2016; 8: 207
        • Basta M.
        • Lin H.M.
        • Pejovic S.
        • Sarrigiannidis A.
        • Bixler E.
        • Vgontzas A.N.
        Lack of regular exercise, depression, and degree of apnea are predictors of excessive daytime sleepiness in patients with sleep apnea: sex differences.
        J Clin Sleep Med. 2008; 4: 19-25
        • Lopes C.
        • Esteves A.M.
        • Bittencourt L.R.
        • Tufik S.
        • Mello M.T.
        Relationship between the quality of life and the severity of obstructive sleep apnea syndrome.
        Braz J Med Biol Res. 2008; 41: 908-913
        • Quan S.F.
        • O'Connor G.T.
        • Quan J.S.
        • et al.
        Association of physical activity with sleep-disordered breathing.
        Sleep Breath. 2007; 11: 149-157
        • West S.D.
        • Kohler M.
        • Nicoll D.J.
        • Stradling J.R.
        The effect of continuous positive airway pressure treatment on physical activity in patients with obstructive sleep apnoea: a randomised controlled trial.
        Sleep Med. 2009; 10: 1056-1058
        • Ryan C.F.
        • Love L.L.
        • Buckley P.A.
        Energy expenditure in obstructive sleep apnea.
        Sleep. 1995; 18: 180-187
        • Stenlof K.
        • Grunstein R.
        • Hedner J.
        • Sjostrom L.
        Energy expenditure in obstructive sleep apnea: effects of treatment with continuous positive airway pressure.
        Am J Physiol. 1996; 271: E1036-E1043
        • Ucok K.
        • Aycicek A.
        • Sezer M.
        • et al.
        Resting metabolic rate and anthropometric measurements in male sleep apnea patients.
        Intern Med. 2011; 50: 833-838
        • Loube D.I.
        • Loube A.A.
        • Erman M.K.
        Continuous positive airway pressure treatment results in weight loss in obese and overweight patients with obstructive sleep apnea.
        J Am Diet Assoc. 1997; 97: 896-897
        • Quan S.F.
        • Budhiraja R.
        • Clarke D.P.
        • et al.
        Impact of treatment with continuous positive airway pressure (CPAP) on weight in obstructive sleep apnea.
        J Clin Sleep Med. 2013; 9: 989-993
        • Redenius R.
        • Murphy C.
        • O'Neill E.
        • Al-Hamwi M.
        • Zallek S.N.
        Does CPAP lead to change in BMI?.
        J Clin Sleep Med. 2008; 4: 205-209
        • Drager L.F.
        • Brunoni A.R.
        • Jenner R.
        • Lorenzi-Filho G.
        • Bensenor I.M.
        • Lotufo P.A.
        Effects of CPAP on body weight in patients with obstructive sleep apnoea: a meta-analysis of randomised trials.
        Thorax. 2015; 70: 258-264
        • Antic N.A.
        • Heeley E.
        • Anderson C.S.
        • et al.
        The Sleep Apnea cardioVascular Endpoints (SAVE) trial: rationale, ethics, design, and progress.
        Sleep. 2015; 38: 1247-1257
        • McEvoy R.D.
        • Antic N.A.
        • Heeley E.
        • et al.
        CPAP for prevention of cardiovascular events in obstructive sleep apnea.
        N Engl J Med. 2016; 375: 919-931
      1. Australian New Zealand Clinical Trials Registry. ACTRN12608000409370. Sleep Apnea cardioVascular Endpoints Study - Investigating the Effectiveness of Treatment With CPAP vs Standard Care in Reducing CV Morbidity and Mortality in Patients With Co-existing CV Disease and Moderate-severe Obstructive Sleep Apnea. (SAVE). www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12608000409370. Verification date February 2015; registered August 2008; last updated November 2016. Accessed October 31, 2018.

        • Barbe F.
        • Duran-Cantolla J.
        • Sanchez-de-la-Torre M.
        • et al.
        Effect of continuous positive airway pressure on the incidence of hypertension and cardiovascular events in nonsleepy patients with obstructive sleep apnea: a randomized controlled trial.
        JAMA. 2012; 307: 2161-2168
        • National Vascular Disease Prevention Alliance
        Guidelines for the Management of Absolute Cardiovascular Disease Risk.
        National Stroke Foundation of Australia, Australia2012 (978-0-9872830-1-6)
        • National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand
        Reducing Risk in Heart Disease: An Expert Guide to Clinical Practice for Secondary Prevention of Coronary Heart Disease.
        National Heart Foundation of Australia, Melbourne, Australia2012 (978-1-74345-016-1)
        • Piepoli M.F.
        • Hoes A.W.
        • Agewall S.
        • et al.
        2016 European guidelines on cardiovascular disease prevention in clinical practice: the Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts) developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR).
        Eur Heart J. 2016; 37: 2315-2381
        • Smith Jr., S.C.
        • Benjamin E.J.
        • Bonow R.O.
        • et al.
        AHA/ACCF secondary prevention and risk reduction therapy for patients with coronary and other atherosclerotic vascular disease: 2011 update: a guideline from the American Heart Association and American College of Cardiology Foundation.
        Circulation. 2011; 124: 2458-2473
        • Barnes E.R.
        • Theeke L.A.
        • Mallow J.
        Impact of the Provider and Healthcare team Adherence to Treatment Guidelines (PHAT-G) intervention on adherence to national obesity clinical practice guidelines in a primary care centre.
        J Eval Clin Pract. 2015; 21: 300-306
      2. World Heart Federation. Secondary Cardiovascular Disease Prevention and Control. www.worldheart.org. World Heart Federation, Geneva, Switzerland: 2014. Accessed February 1, 2018.

        • Marin J.M.
        • Agusti A.
        • Villar I.
        • et al.
        Association between treated and untreated obstructive sleep apnea and risk of hypertension.
        JAMA. 2012; 307: 2169-2176
        • Botros N.
        • Concato J.
        • Mohsenin V.
        • Selim B.
        • Doctor K.
        • Yaggi H.K.
        Obstructive sleep apnea as a risk factor for type 2 diabetes.
        Am J Med. 2009; 122: 1122-1127
        • Molnar M.Z.
        • Mucsi I.
        • Novak M.
        • et al.
        Association of incident obstructive sleep apnoea with outcomes in a large cohort of US veterans.
        Thorax. 2015; 70: 888-895
        • Peppard P.E.
        • Young T.
        • Palta M.
        • Dempsey J.
        • Skatrud J.
        Longitudinal study of moderate weight change and sleep-disordered breathing.
        JAMA. 2000; 284: 3015-3021
        • Epstein L.J.
        • Kristo D.
        • Strollo Jr., P.J.
        • et al.
        Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults.
        J Clin Sleep Med. 2009; 5: 263-276
        • Qaseem A.
        • Holty J.E.
        • Owens D.K.
        • et al.
        Management of obstructive sleep apnea in adults: a clinical practice guideline from the American College of Physicians.
        Ann Intern Med. 2013; 159: 471-483
        • Heatley E.M.
        • Harris M.
        • Battersby M.
        • McEvoy R.D.
        • Chai-Coetzer C.L.
        • Antic N.A.
        Obstructive sleep apnoea in adults: a common chronic condition in need of a comprehensive chronic condition management approach.
        Sleep Med Rev. 2013; 17: 349-355
        • Chirinos J.A.
        • Gurubhagavatula I.
        • Teff K.
        • et al.
        CPAP, weight loss, or both for obstructive sleep apnea.
        N Engl J Med. 2014; 370: 2265-2275
        • Kim R.
        • Kawachi I.
        • Coull B.A.
        • Subramaniam S.V.
        Contribution of socioeconomic factors to the variation in body-mass index in 58 low-income and middle-income countries: an econometric analysis of multilevel data.
        Lancet Glob Health. 2018; 6: e777-e786