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Clinical Studies and Practice

Adhesion molecule increases in sleep apnea: beneficial effect of positive airway pressure and moderation by obesity

International Journal of Obesity volume 39, pages 472–479 (2015)Cite this article

Subjects

Abstract

Background:

Elevated levels of intercellular adhesion molecule 1 (ICAM-1) and vascular cell adhesion molecule 1 (VCAM-1) may contribute to cardiovascular disease and are associated with obstructive sleep apnea (OSA) and obesity. The relationship between OSA and obesity in determining ICAM-1 and VCAM-1 levels, and the effect of treatment, is unclear.

Objective:

Our aim was to study whether positive airway pressure (PAP) usage resulted in changes in ICAM-1 and VCAM-1 after 2 years within 309 OSA patients from the Icelandic Sleep Apnea Cohort, and determine how obesity affected such changes.

Subjects/Methods:

The mean body mass index (BMI) was 32.4±5.1 kg m−2; subjects had moderate-to-severe OSA (apnea–hypopnea index=45.0±20.2) and 79% were male. There were 177 full PAP users (⩾4 h per night and ⩾20 of last 28 nights), 44 partial (<4 h per night or <20 nights) and 88 nonusers.

Results:

ICAM-1 (P<0.001) and VCAM-1 (P=0.012) change was significantly different among the PAP groups. The largest ICAM-1 differences were among the most obese subjects (P<0.001). At follow-up, nonusers had increased ICAM-1 compared with decreased levels in full users. All groups had increased VCAM-1, but nonusers had a significantly larger increase than full users.

Conclusions:

Within moderate-to-severe OSA patients, PAP usage prevents increases in adhesion molecules observed in nonusers after 2 years. For ICAM-1, the largest effect is in the most obese subjects. As OSA and obesity commonly coexist, the usage of PAP to limit increases in adhesion molecules may decrease the rate of progression of OSA-related cardiovascular disease.

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Acknowledgements

We are grateful to Sigrun Gudmundsdottir, Lovisa Gudmundsdottir, Magdalena Osk Sigurgunnarsdottir, Kristján Andri Kristjánsson, Bethany Staley, Matthew Thorne-Fitzgerald, Robert Hachadoorian, Ted Mifflin and the other staff at the Sleep Centers of Landspitali University Hospital and the University of Pennsylvania who helped assemble and analyze the data. We are grateful to Daniel C. Barrett with help in manuscript preparation. The research was supported by NIH grants: HL072067 for ‘A Family Linkage Study of Obstructive Sleep Apnea’; HL094307 for ‘Endophenotypes of Sleep Apnea and Role of Obesity’; HL07973 for ‘Training in Sleep and Sleep Disorders’; 1K99NR014675-01 ‘Mechanisms of Sleepiness Symptoms in Obstructive Sleep Apnea and Cardiovascular Disease’; the Eimskip Fund of the University of Iceland and the Landspitali University Hospital Research Fund.

Author information

Author notes

  1. V M Pak and B T Keenan: First two are co-lead authors.

  2. T Gislason and A I Pack: Last two authors are co-senior authors.

Authors and Affiliations

  1. Center for Sleep and Circadian Neurobiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA

    V M Pak, B T Keenan, N Jackson, G Maislin, R J Schwab & A I Pack

  2. Biobehavioral Research Center, School of Nursing, University of Pennsylvania, Philadelphia, PA, USA

    V M Pak

  3. Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA

    M A Grandner

  4. Division of Sleep Medicine/Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA

    G Maislin, R J Schwab & A I Pack

  5. Monell Chemical Senses Center, Philadelphia, PA, USA

    K Teff

  6. University of Iceland, Medical Faculty, Reykjavik, Iceland

    E S Arnardottir, S Júlíusson, B Benediktsdottir & T Gislason

  7. Landspitali—The National University Hospital of Iceland, Reykjavik, Iceland

    E S Arnardottir, S Júlíusson, B Benediktsdottir & T Gislason

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Correspondence to V M Pak.

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Competing interests

ESA reports personal consulting fees from Nox Medical outside the scope of the submitted work. AIP is the holder of an endowed chair, funds for which were provided by Respironics.

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Pak, V., Keenan, B., Jackson, N. et al. Adhesion molecule increases in sleep apnea: beneficial effect of positive airway pressure and moderation by obesity. Int J Obes 39, 472–479 (2015). https://doi.org/10.1038/ijo.2014.123

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