To investigate the effect of continuous positive airway pressure treatment on regional adipose tissue distribution in patients with moderate or severe obstructive sleep apnoea. Patients received both therapeutic and sham CPAP in random order for 2 months each with an intervening one month washout. Abdominal subcutaneous, visceral and liver fat were quantified using magnetic resonance imaging (MRI) and spectroscopy (MRS). Liver enzymes and plasma glucose were also determined. Measurements were obtained at baseline and at the end of both treatment arms. 38 eligible patients were randomly assigned to a treatment order with 27 patients having complete MRI/MRS data. No significant difference was observed in subcutaneous (-28.6 cm3, p = 0.49) and visceral adipose tissue (-16.8 cm3, p = 0.59), intra-hepatic lipid (-0.2%, p = 0.21) and fasting glucose measurements (-0.1 mmol/L, p = 0.46) between treatment modalities. Alkaline phosphatase decreased (-3.1 U/L, p = 0.02) while on therapeutic CPAP compared with sham CPAP but other liver enzymes including aspartate aminotransferase (0.3 U/L, p = 0.82), alanine aminotransferase (1.34 U/L, p = 0.59) and gamma-glutamyltransferase (-2.3 U/L, p = 0.33) remained unchanged. In this first randomized sham controlled trial, there was no change in adipose tissue distribution after 8 weeks of therapeutic CPAP compared with 8 weeks of sham CPAP. Longer duration of CPAP use may be necessary to demonstrate a difference.
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