Brief report
Intraabdominal fat redistribution in long-term continuous positive airway pressure treatment in obstructive sleep apnea patients
Redistribución de grasa intraabdominal en el tratamiento a largo plazo con presión positiva continua de la vía aérea en los pacientes con síndrome de apnea-hipopnea durante el sueño
Raquel Catalàa,
, Raimón Ferréb, Sandra Sangenísa, Anna Cabréb, Salvador Hernández-Flixa, Lluís Masanab
Corresponding author
a Unidad de Sueño, Sección de Neumología, Hospital Universitari Sant Joan, Institut d’Investigació Sanitària Pere Virgili, Reus, Tarragona, Spain
b Unitat de Recerca en Lípids i Arteriosclerosi, Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Hospital Universitari Sant Joan, Institut d’Investigació Sanitària Pere Virgili, Reus, Tarragona, Spain
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array:3 [ "entidad" => "Unidad de Sueño, Sección de Neumología, Hospital Universitari Sant Joan, Institut d’Investigació Sanitària Pere Virgili, Reus, Tarragona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Unitat de Recerca en Lípids i Arteriosclerosi, Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Hospital Universitari Sant Joan, Institut d’Investigació Sanitària Pere Virgili, Reus, Tarragona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Redistribución de grasa intraabdominal en el tratamiento a largo plazo con presión positiva continua de la vía aérea en los pacientes con síndrome de apnea-hipopnea durante el sueño" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1482 "Ancho" => 2475 "Tamanyo" => 195900 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Comparison of subcutaneous and visceral adipose tissue and preaortic intra-abdominal fat measures in patients with obstructive sleep apnoea syndrome (OSAS) with and without <span class="elsevierStyleItalic">continuous positive airway pressure</span> (CPAP) at baseline and at the end of follow-up (2 years). The results represent the mean and standard deviation of the SAT, VAT and PIF. NS: not significant.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Obstructive sleep apnoea syndrome (OSAS) is a highly prevalent disease that affects between 2% and 4% of middle-aged general population. OSAS increases the development and incidence of metabolic disorders and cardiovascular diseases.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a><span class="elsevierStyleItalic">Continuous positive airway pressure</span> (CPAP) is the treatment of choice for OSAS, and obesity is its main risk factor.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Abdominal fat is distributed between the subcutaneous layer of the skin, viscus and liver. It has been postulated that the deposition of fat in the viscus and subcutaneous tissue is due to the inability of the same to absorb and store excess dietary triglycerides. There is evidence that the severity of OSAS and secondary hypoxaemia correlate better with the amount of visceral fat than with the body mass index (BMI).<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> Currently, the role of CPAP treatment in OSAS regarding body adiposity is unclear. Some short-term observational studies have shown a reduction of <span class="elsevierStyleItalic">visceral adipose tissue</span> (VAT) and <span class="elsevierStyleItalic">subcutaneous adipose tissue</span> (SAT),<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> while others did not observe changes.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">4,5</span></a> Therefore, our objective is to evaluate the long term effect of CPAP in OSAS patients on intraabdominal fat.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Study design and patients</span><p id="par0015" class="elsevierStylePara elsevierViewall">Prospective observational study of cases and controls that included 85 OSAS patients aged between 18 and 75 years who were diagnosed by polysomnography (PSG) in the Sleep Unit (SU) with a follow-up of 2.1 (1.6–2.4) years. The case group consisted of the OSAS patients who met CPAP criteria, and the control group was formed by OSAS patients who were not candidates for CPAP. Subjects with renal failure, recent cardiovascular event, neoplastic disease or significant alcoholism were excluded.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Anthropometric, biochemical and respiratory parameters evaluated at baseline are detailed in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. The <span class="elsevierStyleItalic">Epworth Sleepiness Scale</span> (ESS) was used to quantify the degree of daytime sleepiness. If the score was greater than 10, it was considered as excessive sleepiness. Patients gave written informed consent and the study was approved by the Clinical Research Ethics Committee of our hospital (Reg. No.: 09-10-29/10proj3).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Diagnosis and treatment of obstructive sleep apnoea syndrome</span><p id="par0025" class="elsevierStylePara elsevierViewall">The diagnosis of OSAS was carried out by conventional monitored PSG (eXea; BITMED, Zaragoza, Spain) during the night in the SU in accordance with international standard regulations. The variables analysed are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. The severity of OSAS was established by the apnoea–hypopnea index (AHI) measured in episodes/h: mild, ≥5 and <15; moderate, ≥15 and <30; severe, ≥30. CPAP treatment was indicated in patients with severe OSAS and moderate OSAS associated with cardiovascular disease and/or excessive daytime sleepiness. They were admitted to the SU for one night to titre the effective pressure by automatic or auto CPAP (GoodKnight 420G, Covidien-Nellcor and Puritan Bennett, Boulder, USA).</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Intraabdominal fat determination</span><p id="par0030" class="elsevierStylePara elsevierViewall">Body fat was measured with the ultrasound system MyLab 50 X-Vision Ultrasonograph (Esaote, Italy) according to consensus and validated and reproducible methods, at baseline and at the end of follow-up.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> SAT and VAT were measured with a probe of 7.5<span class="elsevierStyleHsp" style=""></span>MHz perpendicular to the epigastrium skin. The SAT was defined as the distance between the anterior surface of the linea alba and the skin-fat barrier, and VAT, from the anterior surface of the liver (left lobe) to the posterior surface of the linea alba. The <span class="elsevierStyleItalic">preaortic intra-abdominal fat</span> (PIF) was the distance between the anterior wall of the aorta artery and the posterior surface of the rectus abdominis muscle, and measured with a probe of 3.5–3.75<span class="elsevierStyleHsp" style=""></span>MHz, 1–5<span class="elsevierStyleHsp" style=""></span>cm above the midline between the navel and the xiphoid appendix.</p><p id="par0035" class="elsevierStylePara elsevierViewall">All the images were captured by the same professional to avoid interobserver variability.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Statistic analysis</span><p id="par0040" class="elsevierStylePara elsevierViewall">Continuous variables are presented as mean (standard deviation) for data with normal distribution, as median (25th–75th percentile) for data not following a normal distribution and as frequency (n) or percentages (%) for categorical variables. The comparison of means was performed using the analysis of variance and the qualitative variables comparison was performed with <span class="elsevierStyleItalic">χ</span><span class="elsevierStyleSup">2</span>. Bivariate association was analysed with Spearman or Pearson correlations. Bland–Altman analysis was used to determine the interobserver variation in the intra-abdominal fat measurement. The statistical analysis was performed using SPSS version 19.0 (SPSS Inc., Chicago, IL, USA). <span class="elsevierStyleItalic">P</span> values <0.05 were considered significant.</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Results</span><p id="par0045" class="elsevierStylePara elsevierViewall">85 study participants were classified according to the AHI in 3 categories: 22 mild, 20 moderate and 43 severe. The results of 50 OSAS treated with CPAP (43 severe and 7 moderate) and 35 OSAS no candidates to CPAP (22 mild and 13 moderate) were compared, the clinical characteristics of whom are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.</p><p id="par0050" class="elsevierStylePara elsevierViewall">At 2 years of follow-up in the SU, weight and BMI did not change in a statistically significant way in either group. In the OSAS group without CPAP, the SAT and VAT were not changed (11.41 [4.77] vs 11.78 [5.55] mm, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.288, and 16.91 [4.22] vs. 15.93 [3.59] mm, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.211, respectively), showing a significant increase in PIF (55.19 [23.44] vs 63.45 [23.94] mm, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.021). Among OSAS patients treated with CPAP no changes were observed in either VAT or PIF (15.74 [5.79] vs 15.45 [6.73] mm, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.603 and 70.89 [19.64] vs 74.51 [25.38] mm, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.264, respectively), but SAT decreased significantly (11.29 [5.69] vs. 10.47 [5.71] mm, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.012) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">In the CPAP group, ESS score decreased from 11.3 (4.9) 3.3 (3.1) (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001). The absolute intraobserver concordance for SAT, VAT and PIF was −0.14 (0.20) %, −0.35 (0.15) and −0.07% (0.30) %, respectively; concordance range was 0.24 to −0.76%, 0.43 to −0.54%, and −0.67% to 0.03 respectively.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Discussion</span><p id="par0060" class="elsevierStylePara elsevierViewall">Our results show that long-term treatment with CPAP carries a positive redistribution of intra-abdominal fat. The increase of PIF in patients with OSAS untreated with CPAP, the decrease in SAT and the absence of change in PIF in OSAS treated with CPAP is associated with an anthropometric profile of lower cardiovascular risk of positive pressure treatment.</p><p id="par0065" class="elsevierStylePara elsevierViewall">The impact of CPAP on body adiposity has been studied by different authors, but with inconsistent results.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3–5</span></a> According to Sharma et al.,<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> 3-month treatment with CPAP could lead to a redistribution of body fat, with decreased SAT and VAT associated with a decrease of BMI. However, in our study, 2 years after initiation of treatment with CPAP, only a SAT reduction was observed, not so of VAT, and no changes in BMI. Our findings are in line with those described by Vgontzas et al.,<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> evidencing that CPAP has no significant effect on VAT because it does not decrease insulin resistance or the production of proinflammatory cytokines, so closely related to VAT. By contrast, other authors have observed an increase in SAT at 8 months of treatment with CPAP due to an increased BMI and total body mass and lean.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">The decrease of SAT and not of VAT could be correlated with the lack of weight or BMI change of our patients. This finding confirmed the supposed negative effect of CPAP according to a recent meta-analysis, which shows that the treatment of OSAS with CPAP promotes a significant increase in BMI and weight.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">The mechanisms involved in this CPAP-mediated redistribution of fat are not known. Studies from our group have shown that proteins closely related to adipocyte differentiation and the intracellular movement of fatty acids, such as proteins that bind fatty acids, both of adipocyte and epidermal origin (FABP4 and FABP5), change their concentrations and cell expression in OSAS patients and in response to CPAP, probably as a result of hypoxaemic correction and oxidative status improvement.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> However, their participation in the adipocyte redistribution process is purely speculative.</p><p id="par0080" class="elsevierStylePara elsevierViewall">Our study provides the novelty of being the first to analyse the potential impact of CPAP treatment on body adiposity during 2 years of follow up, as previous articles had only analysed 2–8 months.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3–5,7,8</span></a> It is also the first study conducted on OSAS population in which intra-abdominal adiposity has been evaluated by abdominal ultrasound.</p><p id="par0085" class="elsevierStylePara elsevierViewall">One of the main limitations of this study is the comparison of 2 groups of patients with different levels of OSAS severity, but no differences in cardiovascular risk factors. Another limitation is that both groups have a different baseline BMI, being higher in the OSAS treated with CPAP. Abdominal ultrasound also gives us a partial assessment of total fat distribution, although validation and reproducibility studies demonstrate a correct correlation with other imaging techniques and body impedance.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">In conclusion, long-term CPAP treatment in OSAS patients produces a redistribution of intra-abdominal fat; although visceral fat did not change, the fact that perivascular fat did not increase in patients treated with CPAP, along with the decrease in SAT, supports the idea that the CPAP treatment may be associated with a lower cardiovascular risk anthropometric profile.</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conflict of interests</span><p id="par0095" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres733931" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background and objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Patients and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec737679" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres733930" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Fundamento y objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Pacientes y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec737678" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Materials and methods" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Study design and patients" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Diagnosis and treatment of obstructive sleep apnoea syndrome" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Intraabdominal fat determination" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Statistic analysis" ] ] ] 6 => array:2 [ "identificador" => "sec0035" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0040" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0045" "titulo" => "Conflict of interests" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2015-07-23" "fechaAceptado" => "2015-12-17" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec737679" "palabras" => array:3 [ 0 => "Abdominal fat" 1 => "Continuous positive airway pressure" 2 => "Obstructive sleep apnoea" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec737678" "palabras" => array:3 [ 0 => "Grasa abdominal" 1 => "Presión positiva de la vía aérea" 2 => "Apnea del sueño" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background and objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Obesity is the main risk factor for obstructive sleep apnoea (OSA). The aim was to evaluate the long-term effect of continuous positive airway pressure (CPAP) on intraabdominal fat distribution in OSA patients.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Patients and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Fifty OSA patients with and 35 without CPAP treatment criteria were followed-up for 2 years. Visceral and subcutaneous adipose tissue (VAT and SAT) and preaortic intraabdominal fat (PIF) were assessed by sonography.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">In the non-CPAP treated group, SAT and VAT mean values did not change, while a significantly PIF growth was observed (55.19 [23.44] vs. 63.45 [23.94] mm, <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.021). In the CPAP treated group, VAT and PIF mean were not changed, while SAT decreased significantly (11.29 [5.69] vs. 10.47 [5.71] mm, <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.012).</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Long-term CPAP treatment produces intraabdominal fat redistribution and is associated with an anthropometric profile of lower cardiovascular risk in OSA patients.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background and objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Patients and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Fundamento y objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La obesidad es el principal factor de riesgo del síndrome de apneas-hipopneas del sueño (SAHS). El objetivo es evaluar el efecto de la <span class="elsevierStyleItalic">continuous positive airway pressure</span> (CPAP), «presión positiva continua de la vía aérea» a largo plazo en pacientes con SAHS sobre la grasa intraabdominal.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Pacientes y métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron 50 pacientes SAHS con criterio de CPAP y 35 SAHS no candidatos a CPAP con un seguimiento de 2 años. El <span class="elsevierStyleItalic">visceral adipose tissue</span> (VAT, «tejido adiposo visceral»), el <span class="elsevierStyleItalic">subcutaneous adipose tissue</span> (SAT, «tejido adiposo subcutáneo») y la <span class="elsevierStyleItalic">preaortic intraabdominal fat</span> (PIF, «grasa intraabdominal preaórtica») se midieron mediante ecografía.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">En el grupo SAHS no candidatos a CPAP, la media del SAT y del VAT no cambió durante el seguimiento, pero se observó un aumento del PIF (55,19 [23,44] frente a 63,45 [23,94] mm, p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,021). En los pacientes SAHS tratados con CPAP, la media del VAT y del PIF no se modificó, pero el SAT disminuyó a los 2 años del tratamiento con CPAP (11,29 [5,69] frente a 10,47 [5,71] mm, p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,012).</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">El tratamiento con CPAP a largo plazo en los pacientes SAHS produce una redistribución de la grasa intraabdominal y se asocia a un perfil antropométrico de menor riesgo cardiovascular.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Fundamento y objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Pacientes y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Català R, Ferré R, Sangenís S, Cabré A, Hernàndez-Flix S, Masana L. Redistribución de grasa intraabdominal en el tratamiento a largo plazo con presión positiva continua de la vía aérea en los pacientes con síndrome de apnea-hipopnea durante el sueño. Med Clin (Barc). 2016;146:484–487.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1482 "Ancho" => 2475 "Tamanyo" => 195900 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Comparison of subcutaneous and visceral adipose tissue and preaortic intra-abdominal fat measures in patients with obstructive sleep apnoea syndrome (OSAS) with and without <span class="elsevierStyleItalic">continuous positive airway pressure</span> (CPAP) at baseline and at the end of follow-up (2 years). The results represent the mean and standard deviation of the SAT, VAT and PIF. NS: not significant.</p>" ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">CPAP: continuous positive airway pressure; CT90: percentage of time during which the SaO<span class="elsevierStyleInf">2</span> was less than 90%; BMI: body mass index; FEV<span class="elsevierStyleInf">1</span>: Forced expiratory volume in one second; HDL: high density lipoprotein; AHI: apnoea–hypopnea index; LDL: low density lipoprotein; NS: not significant; DBP: diastolic blood pressure; SBP: systolic blood pressure; PIF: preaortic intra-abdominal fat; OSAS: obstructive sleep apnoea syndrome; SaO<span class="elsevierStyleInf">2</span>: arterial oxygen saturation; SAT: subcutaneous adipose tissue; VAT: visceral adipose tissue.</p><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Values are expressed as mean (standard deviation) or percentages.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">OSAS with CPAP<br>n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>50 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">OSAS without CPAP<br>n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>35 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age, years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">51.9 (10) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50.6 (7.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Sex, \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">82 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">80 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Smokers \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hypertension \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">48 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Diabetes mellitus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dyslipidemia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">34 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Obesity \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">68 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">45.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.03 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">BMI, kg/m<span class="elsevierStyleSup">2</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">33 (4.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">29.8 (4.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.002 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">SBP, mmHg \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">132.4 (17.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">122.8 (11.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.006 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">DBP, mmHg \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">78.6 (11.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">76 (11.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Glucose, mmol/l \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 (2.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.3 (0.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total cholesterol, mm/l \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.3 (0.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">c-LDL, mmol/l \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.4 (0.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.4 (0.72) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">c-HDL, mmol/l \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (0.24) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.1 (0.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.02 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Triglycerides, mmol/l \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.4 (0.69) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.5 (0.87) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">No c-HDL, mmol/l \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 (0.96) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.1 (0.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Creatinine, mmol/l \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">75.9 (17.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">77.7 (14) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Baseline Epworth \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11.3 (4.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.5 (5.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.006 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">FEV<span class="elsevierStyleInf">1</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">81.4 (18.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">91.1 (14.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">AHI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">62.6 (29.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14.2 (7.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><0.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">SaO<span class="elsevierStyleInf">2</span> mean \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">91.4 (2.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">94.3 (1.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><0.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">CT90 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22.6 (20.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (5.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><0.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">SAT, mm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11.29 (5.69) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11.41 (4.77) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">VAT, mm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15.74 (5.79) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16.91 (4.22) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">PIF, mm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">70.89 (19.64) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">55.19 (23.44) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1211090.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Baseline characteristics of subjects per group.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "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" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "F. 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