Cardiovascular and metabolic effects of CPAP in obese obstructive sleep apnoea patients.

To the Editors: In a recent issue of the European Respiratory Journal , Coughlin et al. 1 demonstrated that, in Caucasians with untreated obstructive sleep apnoea (OSA), continuous positive airway pressure (CPAP) can improve baroreceptor responsiveness and reduce waking blood pressure within 6 weeks, but that this treatment period was insufficient to modify insulin resistance or change the metabolic profile. This is the first randomised placebo-controlled blinded crossover trial comparing cardiovascular and metabolic outcomes after 6 weeks of therapeutic and sham CPAP in obese symptomatic Caucasians with OSA. We have found similar CPAP effects in obese Japanese OSA patients (table 1⇓). The authors suggested that there is a need to offer multiple modalities of treatment to obese OSA patients if their cardiovascular risk profile is to be successfully modified. We totally agree with their conclusion. However, it may be necessary to address the following unresolved issues. View this table: Table 1— Effect of 6-week continuous positive airway pressure …