Effect of CPAP treatment on adhesion molecules in coronary artery disease with nonsleepy obstructive sleep apnoea: The RICCADSA randomized controlled trial

Abstract

Background: Enhanced levels of vascular adhesion molecule-1 (VCAM-1) and intercellular adhesion molecule-1 (ICAM-1) have been associated with obstructive sleep apnoea (OSA). Impact of continuous positive airway pressure (CPAP) treatment on VCAM-1 and ICAM-1 levels in coronary artery disease (CAD) patients with OSA is unclear. Aims and Objectives: We aimed to evaluate whether CPAP therapy would reduce VCAM-1 and ICAM-1 after one year in a revascularized CAD cohort. Methods: This was one of the secondary outcomes of the RICCADSA trial, conducted in Sweden between 2005 and 2013. In all, 210 adults with nonsleepy OSA (apnea-hypopnea index ≥15/h, and Epworth Sleepiness Scale <10) were included. Participants were randomized to CPAP (n=104), or no-CPAP (n=106). Circulating levels of the adhesion molecules were assessed at baseline and after one year. Results: Median VCAM-1 decreased from 1055 to 979 ng/ml (p=0.02) in CPAP group, and from 1062 to 1034 ng/ml (p=0.95) in no-CPAP group. Similarly, median ICAM-1 reduced from 152 to 115 ng/ml (p<0.001) in CPAP group, and from 146 to 127 ng/ml (p=0.001) in no-CPAP group. Change from baseline in median values did not differ significantly between the groups. In a multivariate linear backward regression model, CPAP use (hrs/night) was associated with the decline in VCAM-1 (β=0.16 [95% CI 5.10-88.14], p=0.028), and tended to be significant with the decrease in the ICAM-1 (p=0.08). Conclusions: There was a natural decrease in the VCAM-1 and ICAM-1 values after one year in this CAD cohort with OSA. The magnitude of the decline was associated with increasing CPAP usage.