Cardiac function after CPAP therapy in patients with chronic heart failure and sleep apnea: a multicenter study.

Abstract

BACKGROUND AND PURPOSE:

Continuous positive airway pressure (CPAP) is an effective treatment for sleep apnea (SA), although the evidence for improving chronic heart failure (CHF) is inconclusive. Our aim was to evaluate the effect of CPAP treatment on the left ventricle ejection fraction (LVEF) among other cardiological variables in a randomized, multicenter, placebo (sham-CPAP)-controlled study.

METHODS:

After the selection procedure, 60 patients with CHF with LVEF<45% and SA with an apnea-hypopnea index (AHI)>10/h were evaluated at baseline, and after 3 months of treatment with optimal CPAP or sham-CPAP. The assessment was based on the LVEF, hypertension, daytime sleepiness (Epworth sleepiness scale [ESS]), quality of life (SF-36), New York Heart Scale (NYHA score), dyspnea (by using the Borg scale) and exercise tolerance (6-min walk test).

RESULTS:

The mean AHI was normalized in the optimal CPAP group but not in the sham-CPAP group. The LVEF showed a significant improvement in the group of patients treated with CPAP (2.5; 95% CI: 0.6 to 4.3), which was not observed in the sham-CPAP group (0.0; 95% CI: -2.1 to 2.1). However, the change in the LVEF from baseline to 3 months was not significantly greater in the whole group (obstructive and Cheyne-Stokes events) treated with CPAP than in the control group (p: 0.07). In patients with only obstructive sleep apnea (OSA), who account for 83% of the total population, there was a significant improvement in the LVEF in the group of patients treated with CPAP but no such improvement in the sham-CPAP group. In this OSA group, the change in the LVEF from baseline to 3 months was significantly greater in the group treated with CPAP than in the sham-CPAP group (p: 0.03). The other variables studied were not modified. When the patients were divided according to the severity of the LVEF (a LVEF cut-off of 30%), improvement was observed in those with a LVEF>30. No changes were found in the other cardiological variables.

CONCLUSIONS:

CPAP therapy proved to be useful in patients with associated sleep-disordered breathing and CHF. The improvement was more marked in patients with a LVEF>30%. However, the increased LVEF in the CPAP group was not accompanied by changes in the other cardiological variables.

• Authors: Carlos J Egea, Felipe Aizpuru, Jose A Pinto, Jose M Ayuela, Eugeni Ballester, Carlos Zamarrón, Agustín Sojo, Josep M Montserrat, Ferran Barbe, Angel Ma Alonso-Gomez, Ramon Rubio, Jose L Lobo, Joaquin Duran-Cantolla, Vanessa Zorrilla, Renny Nuñez, Julia Cortés, Antonio Jiménez, Jose Cifrián, Mónica Ortega, Rosario Carpizo, Antonio Sánchez, Joaquin Terán, Luis Iglesias, Carmen Fernández, Mari Luz Alonso, Jose Cordero, Eulalia Roig, Felix Pérez, Africa Muxi, Francisco Gude, Antonio Amaro, Uxio Calvo, Juan F Masa, Isabel Utrabo, Yolanda Porras, Isabel Lanchas, Esther Sánchez, Spanish Group of Sleep Breathing Disorders
• Journal: Sleep medicine (Sleep Med) Vol. 9 Issue 6 Pg. 660-6 (Aug 2008) ISSN: 1389-9457 [Print] Netherlands
• PMID: 17904420 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Topics

• Aged
• Continuous Positive Airway Pressure
• Exercise Tolerance
• Female
• Heart Failure (complications, physiopathology)
• Humans
• Male
• Middle Aged
• Polysomnography
• Quality of Life
• Sleep Apnea Syndromes (complications, physiopathology, therapy)
• Stroke Volume (physiology)
• Treatment Outcome