Effect of CPAP on Cardiac Function in Minimally Symptomatic Patients with OSA: Results from a Subset of the MOSAIC Randomized Trial.

Abstract

STUDY OBJECTIVES:

Minimally symptomatic obstructive sleep apnea (OSA) is highly prevalent, and the effects of continuous positive airway pressure (CPAP) on myocardial function in these patients are unknown. The MOSAIC randomized, controlled trial of CPAP for minimally symptomatic OSA assessed the effect of CPAP on myocardial function in a subset of patients.

METHODS:

Two centers taking part in the MOSAIC trial randomized 238 patients in parallel to 6 months of CPAP (120) or standard care (118). Of these, 168 patients had echocardiograms, and 68 patients had a cardiac magnetic resonance scan (CMR). A larger group (314) from 4 centers had brain natriuretic peptide (BNP) measured.

RESULTS:

Mean (SD) baseline oxygen desaturation index (ODI) and Epworth sleepiness score (ESS) were 13.5 (13.2), and 8.4 (4.0), respectively. CPAP significantly reduced ESS and ODI. Baseline LV ejection fraction (LVEF) was well preserved (60.4%). CPAP had no significant effect on echo-derived left atrial (LA) area (-1.0 cm2, 95% CI -2.6 to +0.6, p = 0.23) or early to late left ventricular filling velocity (E/A) ratio (-0.01, 95% CI -0.07 to +0.05, p = 0.79). There was a small change in echo-derived LV end diastolic volume (EDV) with CPAP (-5.9 mL, 95% CI -10.6 to -1.2, p = 0.015). No significant changes were detected by CMR on LV mass index (+1.1 g/m(2), 95% CI -5.9 to +8.0, p = 0.76) or LVEF (+0.8%, 95% CI -1.2 to +2.8, p = 0.41). CPAP did not affect BNP levels (p = 0.16).

CONCLUSIONS:

Six months of CPAP therapy does not change cardiac functional or structural parameters measured by echocardiogram or CMR in patients with minimally symptomatic mild-to-moderate OSA.

CLINICAL TRIAL REGISTRATION:

ISRCTN 34164388 (http://isrctn.org).

• Authors: Sonya Craig, Ilias Kylintireas, Malcolm Kohler, Debby Nicoll, Daniel J Bratton, Andrew J Nunn, Paul Leeson, Stefan Neubauer, John R Stradling
• Journal: Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine (J Clin Sleep Med) Vol. 11 Issue 9 Pg. 967-73 (Sep 15 2015) ISSN: 1550-9397 [Electronic] United States
• PMID: 25979104 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial)
• Copyright: © 2015 American Academy of Sleep Medicine.

Topics

• Continuous Positive Airway Pressure (statistics & numerical data)
• Female
• Heart (physiopathology)
• Heart Diseases (complications, physiopathology)
• Humans
• Male
• Middle Aged
• Sleep Apnea, Obstructive (complications, therapy)
• Treatment Outcome