Hair Cortisol Concentrations in Patients with Obstructive Sleep Apnea

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: SUN 50-71-HPA Axis
Sunday, June 16, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board SUN-67
Evan Russell*1, Gideon Koren1, Michael Rieder1, Stan Van Uum2, Kristin K Clemens2, Charles George3 and Brian Rotenberg4
1Western University, 2Western University, London, ON, Canada, 3London Health Sciences Centre, 4St. Joseph's Health Care London
BACKGROUND: Obstructive sleep apnea (OSA) is a common sleep disorder with serious cardiovascular and metabolic co-morbidities that may be mediated by increased cortisol secretion [1,2]. Recent studies have examined the effect of continuous positive airway pressure (CPAP) on cortisol secretion in OSA patients, but the results have been mixed [3-7]. However, these studies used saliva and plasma to measure cortisol, thus only providing point measures of cortisol secretion.  Hair cortisol analysis presents a means of non-invasively and retrospectively examining cortisol production over several months [8].

OBJECTIVES: To determine, in patients with OSA, the effect of CPAP on long-term cortisol exposure assessed by  hair cortisol measurements..

DESIGN AND METHODS: Patients were recruited after OSA was diagnosed using a polysomnogram.  Physical exam information and medical history were recorded.  Polysomnogram data including the apnea-hypopnea index (AHI), total hypoxemic time, and arousals per hour were recorded before and after CPAP.  Additionally, a hair sample and Perceived Stress Scale (PSS) were collected before and after CPAP. Hair cortisol concentrations were determined using our modified salivary cortisol ELISA protocol.

RESULTS: Ninety-two patients were enrolled in the study, of which 31 returned after 3 months of CPAP therapy.  A trend towards increased hair cortisol concentrations was noted when comparing mild OSA patients with moderate and severe OSA patients (P=0.056).  Hair cortisol concentrations were weakly negatively associated with total hypoxemic time (r2=0.06, P<0.05).  CPAP treatment did not change hair cortisol concentrations, but perceived stress was reduced following placement on CPAP (P<0.001).

CONCLUSION: Cortisol secretion may be up-regulated in severe cases of OSA.  While subjectively experienced stress may benefit from 3 months of CPAP treatment, physiological stress may remain.

[1] Patil, S.P., 2010. What every clinician should know about polysomnography. Respir. Care 55(9), 1179-1195.[2]Trakada, G., Chrousos, G., Pejovic, S., Vgontzas, A., 2007. Sleep apnea and its association with the stress system, inflammation, insulin resistance and visceral obesity. Sleep Med. Clin 2(2), 251-261.[3]Carneiro, G., Togeiro, S.M., Hayashi, L.F., Ribeiro-Filho, F.F., Fibeiro, A.B., Tufik, S., Zanella, M.T., 2008. Effect of continuous positive airway pressure therapy on hypothalamic-pituitary-adrenal axis function and 24-h blood pressure profile in obese men with obstructive sleep apnea syndrome. Am. J. Physiol. Endocrinol. Metabol. 295(2), E380-E384. [4]Henley, D.E., Russell, G.M., Douthewaite, J.A., Wood, S.A., Buchanan, F., Gibson, R., Woltersdorf, W.W., Catterall, J.R., Lightman, S.L., 2009. Hypothalamic-pituitary-adrenal axis activation in obstructive sleep apnea: the effect of continuous positive airway pressure therapy. J. Clin. Endocrinol. Metab. 94(11), 4234-4242. [5]Schmoller, A., Eberhardt, F., Jauch-Chara, K., Schweiger, U., Zabel, P., Peters, A., Schultes, B., Oltmanns, K.M., 2009. Continuous positive airway pressure therapy decreases evening cortisol concentrations in patients with severe obstructive sleep apnea. Metabolism 58(6), 848-853. [6]Meston, N., Davies, R.J., Mullins, R., Jenkinson, C., Wass, J.A., Stradling, J.R., 2003. Endocrine effects of nasal contininuous positive airway pressure in male patients with obstructive sleep apnoea. J. Intern. Med. 254(5), 447-454. [7]Tasali, E., Chapotot, F., Leproult, R., Whitmore, H., Ehrmann, D., 2011. Treatment of obstructive sleep apnea improves cardiometabolic function in young obese women with polycystic ovary syndrome. J. Clin. Endocrinol.          Metab. 96(2), 365-374. [8]Russell, E., Koren, G., Rieder, M., Van Uum, S.  2012. Hair cortisol as a biological marker of chronic stress-Current status, future directions, and unanswered questions.  Psychoneuroendocrinology. 37, 589-601.

Nothing to Disclose: ER, GK, MR, SV, KKC, CG, BR

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