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Vol. 55. Issue 4.
Pages 181-228 (April 2019)
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Vol. 55. Issue 4.
Pages 181-228 (April 2019)
Original article
DOI: 10.1016/j.arbr.2018.09.016
Continuous Positive Airway Pressure Treatment Does not Reduce Uric Acid Levels in OSA Women
La Presión Positiva Continua En Las Vías Aéreas No Reduce Los Niveles De Ácido Úrico En Las Mujeres Con Saos
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Francisco Campos-Rodrigueza,g,
Corresponding author
fracamrod@gmail.com

Corresponding author at: Respiratory Department, Hospital Universitario de Valme, Sevilla, Spain.
, Nuria Reyes-Nuñeza, Carlos Queipo-Coronab, Angeles Sanchez-Armengolc, Bernabe Jurado-Gamezd, Jose Cordero-Guevarae, Maria F. Troncosof,g, Araceli Abad-Fernandezh, Julian Caballero-Rodriguezi, Mercedes Martin-Romeroj, Ana Encabo-Motiñok, Lirios Sacristan-Boul, Javier Navarro-Estevam, Maria Somoza-Gonzalezn, Juan F. Masao,g, Maria A. Sanchez-Quirogap, Beatriz Jara-Chinarroq, Belen Orosa-Bertolr, Miguel A. Martinez-Garcias, on behalf of the Spanish Sleep Network
a Respiratory Department, Hospital Universitario de Valme, Sevilla, Spain
b Respiratory Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain
c Medical-Surgical Unit of Respiratory Diseases, Virgen del Rocio University Hospital, Sevilla, Spain
d Department of Respiratory Medicine, Reina Sofia University Hospital, Institute of Biomedical Research Maimonides (IMIBIC), University of Cordoba, Spain
e Unidad de Metodología y Estadística, BioAraba, Vitoria, Spain
f Respiratory Department, Fundación Jimenez Diaz, Madrid, Spain
g Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
h Respiratory Department, Hospital Universitario de Getafe, Madrid, Spain
i Respiratory Department. Hospital Morales Meseguer, Murcia, Spain
j Respiratory Department, Hospital Universitario Virgen de la Victoria, Malaga, Spain
k Respiratory Department, Hospital Severo Ochoa, Madrid, Spain
l Respiratory Department, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
m Respiratory Department, Hospital Dr. Negrin, Gran Canaria, Spain
n Respiratory Department, Consorcio Sanitario de Terrassa, Barcelona, Spain
o Respiratory Department, Hospital San Pedro de Alcantara, Caceres, Spain
p Respiratory Department, Hospital Virgen del Puerto, Caceres, Spain
q Respiratory Department, Hospital Puerta de Hierro, Madrid, Spain
r Respiratory Department, Hospital Dr Peset, Valencia, Spain
s Respiratory Department, Hospital Universitario y Politecnico La Fe, Valencia, Spain
The Spanish Sleep Network is composed of the following individuals
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Table 1. Baseline characteristics of the women included in the study.
Table 2. Changes in serum uric acid measurements between randomized groups.
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Abstract
Objectives

Although an association between uric acid (UA) levels and obstructive sleep apnea (OSA) has been reported, the effect of continuous positive airway pressure (CPAP) on this measure is yet unclear. We aimed to investigate the effect of CPAP therapy on serum UA levels in patients with OSA.

Methods

We conducted a multicenter, open-label, randomized controlled trial in 307 women diagnosed with moderate-to-severe OSA (apnea-hypopnea index [AHI]15) in 19 Spanish Sleep Units. Women were randomized to CPAP (n=151) or conservative treatment (n=156) for 12 weeks. Changes in serum UA measures were assessed on an intention-to-treat basis. Additional analyses were conducted in the subgroup of women with CPAP adherence ≥4h/night and those with UA levels ≥6mg/dl.

Results

Women had a mean (SD) age of 57.1 (10.1) years, median (first–third quartile) body mass index of 33.7 (29.0–38.5) mg/kg2 and AHI of 32.0 (22.6–48.5). The average serum UA measure was 5.11 (1.26) mg/dl, and 80 (26.1%) participants had UA6mg/dl. Compared with the control group, the CPAP group did not achieve any reduction in UA levels (non-adjusted intergroup difference −0.03mg/dl, 95%CI −0.20 to 0.13; p=0.702) after 12 weeks of follow-up. These results did not change when the analysis was restricted to women with CPAP adherence ≥4h/night, or the subgroup of women with hyperuricemia.

Conclusions

Twelve weeks of CPAP therapy does not reduce UA levels compared to conservative treatment in women with moderate-to-severe OSA.

Keywords:
Obstructive sleep apnea
Continuous positive airway pressure
Uric acid
Women
Abbreviations:
AHI
BMI
CPAP
ESS
HbA1c
OSA
SaO2
UA
Resumen
Objetivos

Aunque se ha determinado una asociación entre los niveles de ácido úrico (AU) y el síndrome de apnea obstructiva del sueño (SAOS), el efecto de la presión positiva continua en las vías aéreas (CPAP) en esta medida todavía no está claro. El objetivo fue determinar el efecto de la CPAP en los niveles séricos de AU en pacientes con SAOS.

Métodos

Se llevó a cabo un ensayo abierto, aleatorizado, controlado, multicéntrico en 307 mujeres diagnosticadas con SAOS de moderado a grave (índice de apneas-hipopneas [IAH]15) en 19 unidades del sueño españolas. Fueron aleatorizadas a recibir CPAP (n=151) o tratamiento conservador (n=156) durante 12 semanas. Los cambios en las medidas de AU sérico se estimaron mediante análisis por intención de tratar. Se llevaron a cabo análisis adicionales en el subgrupo de mujeres con adherencia a CPAP4h/noche y en aquellas con niveles de AU6mg/dl.

Resultados

La edad media (DE) de las participantes fue 57,1 (10,1) años, la mediana (primer y tercer cuartil) del índice de masa corporal 33,7 (29,0-38,5) mg/kg2 y el IAH 32,0 (22,6-48,5). El nivel medio de AU fue 5,11 (1,26) mg/dl, y 80 (26,1%) participantes tuvieron AU6mg/dl. Comparado con el grupo control, el grupo CPAP no consiguió ninguna reducción de los niveles de AU (diferencia intergrupo no ajustada: 0,03mg/dl; IC 95%: 0,20-0,13; p=0,702) tras 12 semanas de seguimiento. El análisis no varió cuando se restringió a las mujeres con adherencia a CPAP4h/noche o al subgrupo de mujeres con hiperuricemia.

Conclusiones

Doce semanas de terapia con CPAP no reducen los niveles de AU en comparación con el tratamiento conservador en mujeres con SAOS de moderado a grave.

Palabras clave:
Apnea obstructiva del sueño
Presión positiva continua de las vías aéreas
ácido úrico
Mujeres

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