Differente efficacia della terapia CPAP Ed AutoCPAP in soggetti con apnee ostruttive durante sonno (OSAS): Risultati preliminari

Background: In recent years OSAS has been linked to a higher relative risk of metabolic syndrome and hypertension. CPAP is the first-line therapy for OSAS since it seems to reduce hypersomnolence, and improves cardiovascular and metabolic outcomes. AutoCPAP is a recent alternative treatment to CPAP, that improves OSAS symptoms and long-term CPAP adherence and reduces high CPAP-tritation costs. However the impact of AutoCPAP therapy on cardiovascular and metabolic outcomes in OSAS patients is still unknown. Aim: To evaluate the effects induced by CPAP or AutoCPAP treatments on heart rate, bloodpressure, insulin-resistance, and C-reactive protein in patients with OSAS. Methods: In 18 adult subjects (14 M, 4 F) with severe OSAS (AHI 45.1 ± 16.2, ODI 39.5 ± 16.2, Epworth scores 15.3 ± 2.5), Insulin-Resistance index*, CRP blood levels, and systolic/diastolic blood pressure were measured. After standard CPAP tritation study, all subjects were treated randomly with CPAP or AutoCPAP home treatment. CPAP and AutoCPAP compliance were recorded by a built-in clock-counter. After 3 months of treatment patients performed a complete cardiopulmonary sleep study during CPAP or AutoCPAP. After each test ESS, CRP, HOMA-IR, BP were recorded the following morning. Results: The two treatment groups were matched for age, sex, severity of OSAS (AHI, ODI, mean-SaO₂, nadir-SaO₂ and ESS). Also BP, HOMA-IR* and CRP were found similar between the two groups. After a 3-months control residual AHI and ODI, during therapy were significantly higher in AutoCPAP group than CPAP group. Compliance to therapy was similar in both groups. BMI was not different. However we found a statistically significant reduction (p-paired-Student T-Test. P <0.005) in the CPAP group facing sistolic BP, diastolic BP, HOMA-IR and CRP but not in AutoCPAP group. Conclusion: Our preliminary results, even if limited by the small population sample, seem to suggest a different impact between AutoCPAP and CPAP treatments regarding insulin-resistance, blood pressure and CRP levels. This may be due to the higher residual AHI or ODI.