The Effects of Continuous Positive Airway Pressure on Myocardial Energetics in Patients With Heart Failure and Obstructive Sleep Apnea

Abstract

In this cohort of patients with HF and OSA, short-term CPAP decreased oxidative metabolism and tended to decrease SVI, but did not alter cardiac efficiency. Longer term CPAP improved cardiac efficiency, indicating an energy-sparing effect. These effects may contribute to the benefits of CPAP therapy.

Sleep Apnea and Cardiovascular Disease

“…181 Finally, data obtained in heart failure patients with OSA, using cardiac C-11 acetate positron emission tomography, suggest a potential role for CPAP therapy in modulating myocardial energetics and metabolic efficiency in the failing heart. 182,183 Heart failure patients with coexisting OSA are exposed to adrenergic activation during sleep 5 and when awake. BP rises above, rather than descends below, waking values.…”

In-Hospital Treatment of Obstructive Sleep Apnea During Decompensation of Heart Failure

“…PAP is also suggested to reduce afterload by increasing the intrathoracic pressure and to improve the myocardiac energy requirement. 32,33 Left ventricular wall stress is mainly determined by the systolic BP and LVESV.…”

Tight software, methodological/physiological variation, less so

“…The ability to measure MBFrst and MVO2 with a single tracer injection makes the PET 11 C-acetate a very attractive one. 1,[3][4][5][6] List mode data acquisition also makes possible measurement of LV end diastolic and systolic volumes as well as LV mass and hence MEE. 7 Thus, parenthetically, any variation in test-retest repeatability related to non-simultaneous acquisition of PET and echo data alluded to by the authors potentially could have been mitigated had list mode acquisition of the PET data been obtained.…”