title: Cardiac function after CPAP therapy in patients with chronic heart failure and sleep apnea: a multicenter study.
abstract: 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.
authors: Hospital Txagorritxu, Vitoria, Spain. family@euskalnet.net
authors: Carlos J
authors: CJ
authors: Egea
authors: Felipe
authors: F
authors: Aizpuru
authors: Jose A
authors: JA
authors: Pinto
authors: Jose M
authors: JM
authors: Ayuela
authors: Eugeni
authors: E
authors: Ballester
authors: Carlos
authors: C
authors: Zamarrón
authors: Agustín
authors: A
authors: Sojo
authors: Josep M
authors: JM
authors: Montserrat
authors: Ferran
authors: F
authors: Barbe
authors: Angel Ma
authors: AM
authors: Alonso-Gomez
authors: Ramon
authors: R
authors: Rubio
authors: Jose L
authors: JL
authors: Lobo
authors: Joaquin
authors: J
authors: Duran-Cantolla
authors: Vanessa
authors: V
authors: Zorrilla
authors: Renny
authors: R
authors: Nuñez
authors: Julia
authors: J
authors: Cortés
authors: Antonio
authors: A
authors: Jiménez
authors: Jose
authors: J
authors: Cifrián
authors: Mónica
authors: M
authors: Ortega
authors: Rosario
authors: R
authors: Carpizo
authors: Antonio
authors: A
authors: Sánchez
authors: Joaquin
authors: J
authors: Terán
authors: Luis
authors: L
authors: Iglesias
authors: Carmen
authors: C
authors: Fernández
authors: Mari Luz
authors: ML
authors: Alonso
authors: Jose
authors: J
authors: Cordero
authors: Eulalia
authors: E
authors: Roig
authors: Felix
authors: F
authors: Pérez
authors: Africa
authors: A
authors: Muxi
authors: Francisco
authors: F
authors: Gude
authors: Antonio
authors: A
authors: Amaro
authors: Uxio
authors: U
authors: Calvo
authors: Juan F
authors: JF
authors: Masa
authors: Isabel
authors: I
authors: Utrabo
authors: Yolanda
authors: Y
authors: Porras
authors: Isabel
authors: I
authors: Lanchas
authors: Esther
authors: E
authors: Sánchez
mesh_terms: 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