Controlled Trial of Continuous Positive Airway Pressure in Obstructive Sleep Apnea and Heart Failure

Abstract

Obstructive sleep apnea (OSA) is highly prevalent among patients with congestive heart failure (CHF) and may contribute to progression of cardiac dysfunction via hypoxia, elevated sympathetic nervous system activity, and systemic hypertension. Our aim was to assess the long-term effect of OSA treatment with nocturnal continuous positive airway pressure (CPAP) on systolic heart function, sympathetic activity, blood pressure, and quality of life in patients with CHF. Fifty-five patients with CHF and OSA were randomized to 3 months of CPAP or control groups. End points were changes in left ventricular ejection fraction, overnight urinary norepinephrine excretion, blood pressure, and quality of life. Nineteen patients in the CPAP group and 21 control subjects completed the study. Compared with the control group, CPAP treatment was associated with significant improvements in left ventricular ejection fraction (delta 1.5 +/- 1.4% vs. 5.0 +/- 1.0%, respectively, p = 0.04), reductions in overnight urinary norepinephrine excretion (delta 1.6 +/- 3.7 vs. -9.9 +/- 3.6 nmol/mmol creatinine, p = 0.036), and improvements in quality of life. There were no significant changes in systemic blood pressure. In conclusion, treatment of OSA among patients with CHF leads to improvement in cardiac function, sympathetic activity, and quality of life.

Clinical Phenotypes in Heart Failure With Preserved Ejection Fraction

“…In patients with HFrEF, CPAP improves functional class and reduces sympathetic activity, heart rate, and blood pressure 266, 267, 268. Furthermore, OSA therapy is associated with a trend toward improvement in survival 269.…”

Rehabilitation of Cardiovascular Disorders and Sleep Apnea

“…128 It also improved systolic function, blood pressure, and heart rate. [129][130][131] In long-term studies, CPAP decreased mortality and improved hospitalization-free survival in patients with HF and OSA. 132,133 However, there are no double-blind randomized, controlled trials to evaluate these effects, particularly in the rehabilitation setting.…”

Sleep-related breathing disorders and non-invasive ventilation

“…Recent studies in patients with chronic heart failure associated with obstructive sleep apnea have shown a further improvement of cardiac function in patients treated with bilevel positive airway pressure ventilation (BIPAP). 8 The periodic breathing, Cheyne-Stokes respiration is a particular variety of central sleep apnea which is frequently associated with congestive heart failure.…”