• Sara Q C Giampá, Sofia F Furlan, Lunara S Freitas, Thiago A Macedo, Adriana Lebkuchen, Karina H M Cardozo, Valdemir M Carvalho, Franco C Martins, Indira F B Azam, Valéria Costa-Hong, Heno F Lopes, Mariana L Baptista, Carlos E Rochitte, Luiz A Bortolotto, Geraldo Lorenzi-Filho, and Luciano F Drager.
• Programa de Pós-Graduação em Cardiologia da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
• Chest. 2022 May 1; 161 (5): 1370-1381.

BackgroundOSA is associated with metabolic syndrome (MS), but it is unclear whether OSA treatment with CPAP can revert MS.Research QuestionDoes OSA treatment with CPAP per se have effects on the MS reversibility and the associated metabolic, adiposity and vascular parameters?Study Design And MethodsThe TREATOSA-MS trial is a randomized placebo-controlled trial that enrolled adult patients with a recent diagnosis of MS and moderate or severe OSA (apnea-hypopnea index [AHI], ≥ 15 events/h) to undergo therapeutic CPAP or nasal dilator strips (placebo group) for 6 months. Before and after each intervention, we measured anthropometric variables, BP, glucose, and lipid profile. To control potential-related mechanisms and consequences, we also measured adiposity biomarkers (leptin and adiponectin), body composition, food intake, physical activity, subcutaneous and abdominal fat (visceral and hepatic fat), and endothelial function.ResultsOne hundred patients (79% men; mean age, 48 ± 9 years; BMI, 33 ± 4 kg/m2; AHI, 58 ± 29 events/h) completed the study (n = 50 per group). The mean CPAP adherence was 5.5 ± 1.5 h/night. After 6 months, most patients with OSA randomized to CPAP retained the MS diagnosis, but the rate of MS reversibility was higher than observed in the placebo group (18% vs 4%; OR, 5.27; 95% CI, 1.27-35.86; P = .04). In the secondary analysis, CPAP did not promote significant reductions in the individual components of MS, weight, hepatic steatosis, lipid profile, adiponectin, and leptin, but did promote a very modest reduction in visceral fat and improved endothelial function (all analyses were adjusted for baseline values).InterpretationDespite the higher rate of MS reversibility after CPAP therapy as compared with placebo, most patients retained this diagnosis. The lack of significant or relevant effects on adiposity biomarkers and depots supports the modest role of OSA in modulating MS.Trial RegistrationClinicalTrials.gov; No.: NCT02295202; URL: www.Clinicaltrialsgov.Copyright © 2022 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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