Cardiac function after CPAP therapy in patients with chronic heart failure and sleep apnea: a multicenter study.
OBJECTIVE
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.
Egea
Carlos J
CJ
Hospital Txagorritxu, Vitoria, Spain. family@euskalnet.net
Aizpuru
Felipe
F
Pinto
Jose A
JA
Ayuela
Jose M
JM
Ballester
Eugeni
E
Zamarrón
Carlos
C
Sojo
Agustín
A
Montserrat
Josep M
JM
Barbe
Ferran
F
Alonso-Gomez
Angel Ma
AM
Rubio
Ramon
R
Lobo
Jose L
JL
Duran-Cantolla
Joaquin
J
Zorrilla
Vanessa
V
Nuñez
Renny
R
Cortés
Julia
J
Jiménez
Antonio
A
Cifrián
Jose
J
Ortega
Mónica
M
Carpizo
Rosario
R
Sánchez
Antonio
A
Terán
Joaquin
J
Iglesias
Luis
L
Fernández
Carmen
C
Alonso
Mari Luz
ML
Cordero
Jose
J
Roig
Eulalia
E
Pérez
Felix
F
Muxi
Africa
A
Gude
Francisco
F
Amaro
Antonio
A
Calvo
Uxio
U
Masa
Juan F
JF
Utrabo
Isabel
I
Porras
Yolanda
Y
Lanchas
Isabel
I
Sánchez
Esther
E
D000368:Aged; D045422:Continuous Positive Airway Pressure; D017079:Exercise Tolerance; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017286:Polysomnography; D011788:Quality of Life; D012891:Sleep Apnea Syndromes / Q000150:complications / Q000503:physiopathology* / Q000628:therapy*; D013318:Stroke Volume / Q000502:physiology*; D016896:Treatment Outcome