To evaluate whether parameters of obstructive sleep apnoea (OSA) associate with cholesterol metabolism before and after weight reduction, 42 middle-aged overweight subjects with mild OSA were randomised to intensive lifestyle intervention ( ) or to control group ( ) with routine lifestyle counselling only. Cholesterol metabolism was evaluated with serum noncholesterol sterol ratios to cholesterol, surrogate markers of cholesterol absorption (cholestanol and plant sterols) and synthesis (cholestenol, desmosterol, and lathosterol) at baseline and after 1-year intervention. At baseline, arterial oxygen saturation ( ) was associated with serum campesterol ( ) and inversely with desmosterol ratios ( ) independently of gender, BMI, and homeostasis model assessment index of insulin resistance (HOMA-IR). Apnoea-hypopnoea index (AHI) was not associated with cholesterol metabolism. Weight reduction significantly increased and serum cholestanol and decreased AHI and serum cholestenol ratios. In the groups combined, the changes in AHI were inversely associated with changes of cholestanol and positively with cholestenol ratios independent of gender and the changes of BMI and HOMA-IR ( ). In conclusion, mild OSA seemed to be associated with cholesterol metabolism independent of BMI and HOMA-IR. Weight reduction increased the markers of cholesterol absorption and decreased those of cholesterol synthesis in the overweight subjects with mild OSA. 1. Introduction Obstructive sleep apnoea (OSA) characterized by repeated episodes of apnoea and hypopnoea during sleep is one of the most common sleep disturbances . OSA is independently associated with hypertension, cardiovascular diseases, metabolic syndrome, insulin resistance, and type 2 diabetes [2–7]. Furthermore, recent epidemiological studies have concluded that OSA is an important risk factor for mortality, particularly due to coronary artery disease [8, 9]. However, the underlying mechanisms explaining these associations are rather complex, and although several possibilities have been proposed, they are not entirely accepted. In general, atherogenesis as well as OSA is considered as slow processes, and the onset is likely to begin years before any symptoms appear. We have earlier demonstrated that even mild OSA is associated with the activation of the proinflammatory system . Furthermore, since elevated LDL cholesterol level is one of the most important risk factors for cardiovascular diseases, the question raises whether OSA has a role in hypercholesterolaemia or in cholesterol metabolism. In some, but not in
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