Benefit of Intensive Atorvastatin Therapy in Sleep Apnea Syndrome with Cardiovascular Disease

Background: In addition to its hypolipidemic effect, atorvastatin therapy has multiple beneficial effects in patients with cardiovascular disorders. We evaluated the effect of intensive atorvastatin therapy on sleep apnea syndrome (SAS). Methods: Eighteen patients with apnea-hypopnea index (AHI) ≥5, as assessed by portable monitor, received oral atorvastatin 10 mg/d in the first week and 20 mg/d in the second and third weeks as the preliminary group. Sixteen patients with AHI≥15, as assessed by laboratory polysomnography, received 20 mg/d for two months followed by 40 mg/d for the next two months as the intensive group. If AHI did not reduce by half or to < 15, patients received 60 mg/d from the 5th month onwards. Results: In the preliminary group, after short-term moderate-dose therapy, AHI was significantly decreased (21.7±13.6 vs. 13.6±12.9, P=0.015), along with a significant increase in average arterial oxyhemoglobin saturation (SaO2) (93.1±2.0 % vs. 93.8±1.2 %, P=0.039). In the intensive group, after mid-term titrated intensive therapy, there was a significantly greater reduction in AHI (36.6±19.8 vs. 11.5±11.5, P=0.0004) with increase in average SaO2 (93.6±2.1% vs. 94.0±1.2%, P=0.017) and minimum SaO2 (71.3±9.5 % vs. 84.3±7.7%, P<0.0001). During follow-up of intensive therapy group, 8 patients (50%) showed a decrease in AHI to < 5 events/h. The degree of AHI reduction and SaO2 amelioration in the intensive group was greater than that in the preliminary group (P<0.01). Conclusions: Atorvastatin therapy may help reduce AHI and ameliorate hypoxia in patients with SAS. Mid-term intensive dose atorvastatin therapy may be better than short-term moderate dose in this respect. Funding Statement: Financial support was granted by a Natural Science Fund (09ZR1427500) of the Science and Technology Commission of Shanghai Municipality and a Project for Public Technology Study and Social Development (2010C33SA390002) of Zhejiang Province. Declaration of Interests: No conflict of interest exists for any of the authors. Ethics Approval Statement: Our study was approved by Local Ethical Committee in April 1st 2010 (No 201003, Ethical Committee, Yueqing Hospital, Wenzhou Medical University).