Beneficial effect of bilevel positive airway pressure on left ventricular function in ambulatory patients with idiopathic dilated cardiomyopathy and central sleep apnea-hypopnea: a preliminary study.
BACKGROUND
Sleep-disordered breathing is common in individuals with left ventricular (LV) dysfunction and has been treated with nocturnal positive airway pressure. We investigated whether treatment of central sleep apnea-hypopnea with bilevel positive airway pressure (BPAP) in ambulatory patients with idiopathic dilated cardiomyopathy (IDCM) might improve LV function.


METHODS
Fifty-two consecutive patients with IDCM who underwent both cardiac catheterization and standard polysomnography were enrolled in the study; individuals with obstructive sleep apnea syndrome were excluded. Subjects with an apnea-hypopnea index (AHI) >or= 20 episodes per hour were randomized to receive medical therapy either alone (n = 11) or together with BPAP (n = 10).


RESULTS
LV end-diastolic pressure, pulmonary capillary wedge pressure, and plasma concentration of brain natriuretic peptide were significantly greater, and LV ejection fraction (LVEF) was significantly lower in patients with an AHI >or= 20/h (n = 21, 40.4%) than in those with an AHI < 20/h (n = 31, 59.6%). LVEF (30.5 +/- 1.6% vs 50.8 +/- 3.5%, p < 0.001) [mean +/- SE] and plasma concentration of brain natriuretic peptide (162.8 +/- 44.5 pg/mL vs 32.7 +/- 17.6 pg/mL, p = 0.02) were significantly increased and decreased, respectively, after treatment with BPAP (daily use, 4.8 +/- 0.3 h) for 3 months, whereas these parameters remained unchanged in the control subjects.


CONCLUSIONS
Our findings suggest that treatment of coexisting central sleep apnea-hypopnea with BPAP improves LV function in ambulatory patients with IDCM. BPAP should thus be considered as a nonpharmacologic adjunct to conventional drug therapy in such patients.
Noda
Akiko
A
Nagoya University School of Health Sciences, 1-1-20 Daiko, Minami, Nagoya, Aichi 461-8673, Japan. a-noda@met.nagoya-u.ac.jp
Izawa
Hideo
H
Asano
Hiroyuki
H
Nakata
Seiichi
S
Hirashiki
Akihiro
A
Murase
Yosuke
Y
Iino
Shigeo
S
Nagata
Kohzo
K
Murohara
Toyoaki
T
Koike
Yasuo
Y
Yokota
Mitsuhiro
M
D000328:Adult; D000368:Aged; D001794:Blood Pressure / Q000502:physiology; D002311:Cardiomyopathy, Dilated / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D017286:Polysomnography; D011175:Positive-Pressure Respiration / Q000379:methods*; D011446:Prospective Studies; D011669:Pulmonary Wedge Pressure / Q000502:physiology; D012891:Sleep Apnea Syndromes / Q000503:physiopathology / Q000628:therapy*; D020182:Sleep Apnea, Central / Q000503:physiopathology / Q000628:therapy*; D013318:Stroke Volume / Q000502:physiology; D016019:Survival Analysis; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology*; D014851:Wakefulness / Q000502:physiology
D020097:Natriuretic Peptide, Brain