Exp Clin Endocrinol Diabetes 2006; 114 - P09_120
DOI: 10.1055/s-2006-933005

CPAP therapy decreases evening cortisol levels in patients with severe obstructive sleep apnea

A Schmoller 1, F Eberhardt 2, B Schultes 3, U Schweiger 1, J Born 4, P Zabel 2, HL Fehm 3, A Peters 3, KM Oltmanns 5
  • 1University of Lübeck, Clinic of Psychiatry and Psychotherapy, Lübeck, Germany
  • 2University of Lübeck, Medical Clinic III, Lübeck, Germany
  • 3University of Lübeck, Medical Clinic I, Lübeck, Germany
  • 4University of Lübeck, Department of Neuroendocrinology, Lübeck, Germany
  • 5University of Lübeck, Clinic of Psychiatry and Psychotherapy and Department of Neuroendocrinology, Lübeck, Germany

Aims: Patients with obstructive sleep apnea (OSAS) show an activation of the stress systems reflected by increased plasma and urine concentrations of epinephrine (E) and norepinephrine (NE). Treatment with continuous positive airway pressure (CPAP) decreases plasma E, but not NE levels. An effect of CPAP therapy on hypothalamic-pituitary-adrenal (HPA) axis activation has not been demonstrated as yet.

Methods: We performed a clinical study including 50 patients with OSAS and an apnea-hypopnea-index (AHI) >40. Diurnal profiles of salivary cortisol levels were compiled before and after 3 months of treatment with continuous positive airway pressure (CPAP). Six cortisol samples were collected before and after lunch, in the evening, the next morning after awake and before and after breakfast.

Results: 38 patients returned after 3 months of CPAP therapy for follow-up. We found that cortisol levels before and after CPAP therapy were within the normal range. However, subjects with severe OSAS showed a significant decrease (P=0.038) of evening cortisol levels.

Conclusion: We conclude that severe OSAS causes an alteration of the HPA axis with increased cortisol levels in the evening. It seems that primarily patients with a severe OSAS would benefit from CPAP therapy with respect to alterations of the HPA axis.