PS 17-18 DYNAMICS OF PARAMETERS OF ENDOTHELIAL FUNCTION IN PATIENTS WITH TYPE 2 DIABETES ACCORDING TO FLOW-MEDIATED DILATION DURING THE CPAP-THERAPY

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Abstract

Objective:

To evaluate the effect of CPAP therapy on endothelial function in patients with type 2 diabetes mellitus (DM), combined with moderate to severe obstructive sleep apnea (OSA).

Design and method:

The study involved 42 people with diabetes combined with hypertension of 1–2 degrees and moderate-to-severe OSAS. 22 patients (group 1 - CPAP) in addition to antihypertensive treatment received a 12-week CPAP-therapy by device «Somnobalance e» (Weinmann, Germany). The 2nd (control - C) group consisted of 20 patients with diabetes who were on drug therapy without treatment by CPAP. The subjects were matched by age, sex, height, office BP values. Assessment of respiratory disorders during sleep was performed by cardiorespiratory monitoring SOMNOcheck2 (Weinmann, Germany). Endothelial function was evaluated by flow-mediated vasodilation using the MyLab 90 ultrasound machine (Esaote, Italy). The index of reactivity (IR), and flow-mediated dilation (FMD) have been determined. We evaluated the diameter of the common carotid artery (DCCA) and the intima-media thickness (IMT).

Results:

Before treatment, there were no significant differences between the comparison groups in all parameters, reflecting endothelial function. In CPAP group the initial values of IR were 1,3 ± 0,3, FMD - 8,4 ± 4,9%, DCCA - 7 ± 1,1 mm, IMT - 1,1 ± 0,2 mm. During the treatment an increase of IR to 1,5 ± 0,3 (15,7%; p < 0,05) and FMD to 12,2 ± 3,0% (45,2%; p < 0,05) has been revealed. DCCA and IMT values after 12 weeks decreased to 6,95 ± 1,1 mm (p > 0,05) and 1,0 ± 0,1 mm, respectively (p < 0,05). In group C baseline values of IR were 1,2 (1,1; 1,4), FMD – 7,5 (5; 9,52)%, DOS – 6,2 (5,45; 6,5) mm, IMT - 1,0 ± 0,1 mm. In group C the FMD parameter increased to 8,9 ± 5,3% (15,5%; p < 0,05), IR values, DCCA and IMT were not changed and amounted to 1,5 ± 0,4; 5,7 ± 1,0 mm and 1,0 ± 0,1 m/s, respectively.

Conclusions:

The application of CPAP contributes to a significant improvement in endothelial function according to flow-mediated dilation.

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