title: Acute and chronic effects of continuous positive airway pressure therapy on left ventricular systolic and diastolic function in patients with obstructive sleep apnea and congestive heart failure.
abstract: BACKGROUND
  Obstructive sleep apnea (OSA) may contribute to the pathogenesis of congestive heart failure (CHF). Nocturnal continuous positive airway pressure (CPAP) therapy can alleviate OSA and may have a role in the treatment of CHF patients.
  
  
  OBJECTIVE
  To investigate the acute and chronic effects of CPAP therapy on left ventricular systolic function, diastolic function and filling pressures in CHF patients with OSA.
  
  
  METHODS
  Twelve patients with stable CHF (New York Heart Association II or III, radionuclide ejection fraction lower than 40%) underwent overnight polysomnography to detect OSA. In patients with OSA (n=7), echocardiography was performed at baseline (awake, before and during acute CPAP administration) and after 6.9+/-3.3 weeks of nocturnal CPAP therapy. Patients without OSA (n=5) did not receive CPAP therapy, but underwent a baseline and follow-up echocardiogram.
  
  
  RESULTS
  In CHF patients with OSA, acute CPAP administration resulted in a decrease in stroke volume (44+/-15 mL versus 50+/-14 mL, P=0.002) and left ventricular ejection fraction ([LVEF] 34.8+/-5.0% versus 38.4+/-3.3%, P=0.006) compared with baseline, but no change in diastolic function or filling pressures (peak early diastolic mitral annular velocity [Ea]: 6.0+/-1.6 cm/s versus 6.3+/-1.6 cm/s, P not significant; peak early filling velocity to peak late filling velocity [E/A] ratio: 1.05+/-0.74 versus 1.00+/-0.67, P not significant; E/Ea ratio: 10.9+/-4.1 versus 11.3+/-4.1, P not significant). In contrast, chronic CPAP therapy resulted in a trend to an increase in stroke volume (59+/-19 mL versus 50+/-14 mL, P=0.07) and a significant increase in LVEF (43.4+/-4.8% versus 38.4+/-3.3%, P=0.01) compared with baseline, but no change in diastolic function or filling pressures (Ea: 6.2+/-1.2 cm/s versus 6.3+/-1.6 cm/s, P not significant; E/A ratio: 1.13+/-0.61 versus 1.00+/-0.67, P not significant; E/Ea ratio: 12.1+/-2.7 versus 11.3+/-4.1, P not significant). There was no change in left ventricular systolic function, diastolic function or filling pressures at follow-up in CHF patients without OSA.
  
  
  CONCLUSIONS
  Acute CPAP administration decreased stroke volume and LVEF in stable CHF patients with OSA. In contrast, chronic CPAP therapy for seven weeks improved left ventricular systolic function, but did not affect diastolic function or filling pressures. The potential clinical implications of the discrepant effects of CPAP therapy on left ventricular systolic and diastolic function in CHF patients with OSA warrant further study.
authors.affiliation: Department of Medicine, University of Ottawa, Ottawa, Canada.
authors.forename: Chris B
authors.initials: CB
authors.lastname: Johnson
authors.forename: Rob S
authors.initials: RS
authors.lastname: Beanlands
authors.forename: Keiichiro
authors.initials: K
authors.lastname: Yoshinaga
authors.forename: Haissam
authors.initials: H
authors.lastname: Haddad
authors.forename: Judith
authors.initials: J
authors.lastname: Leech
authors.forename: Rob
authors.initials: R
authors.lastname: de Kemp
authors.forename: Ian G
authors.initials: IG
authors.lastname: Burwash
mesh_terms: D045422:Continuous Positive Airway Pressure; D003971:Diastole / Q000502:physiology*; D015150:Echocardiography, Doppler; D005260:Female; D006333:Heart Failure / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D020181:Sleep Apnea, Obstructive / Q000503:physiopathology / Q000628:therapy*; D013318:Stroke Volume / Q000502:physiology; D013599:Systole / Q000502:physiology*; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000503:physiopathology*
references.citation: Am J Respir Crit Care Med. 2001 Feb;163(2):344-8
references.pmid: 11179104
references.citation: Circulation. 1990 Feb;81(2 Suppl):III78-86
references.pmid: 1967559
references.citation: Circulation. 1998 Nov 24;98(21):2269-75
references.pmid: 9826313
references.citation: J Am Coll Cardiol. 1997 Nov 15;30(6):1527-33
references.pmid: 9362412
references.citation: Am Rev Respir Dis. 1993 Mar;147(3):630-4
references.pmid: 8442598
references.citation: Lancet. 2002 Jul 20;360(9328):237-45
references.pmid: 12133673
references.citation: N Engl J Med. 2003 Mar 27;348(13):1233-41
references.pmid: 12660387
references.citation: Lancet. 2002 Jan 19;359(9302):204-10
references.pmid: 11812555
references.citation: Circulation. 2003 Apr 8;107(13):1822-6
references.pmid: 12682029
references.citation: J Am Soc Echocardiogr. 1989 Sep-Oct;2(5):358-67
references.pmid: 2698218
references.citation: Am J Respir Crit Care Med. 1996 Apr;153(4 Pt 1):1333-8
references.pmid: 8616563
references.citation: J Am Coll Cardiol. 2005 Apr 19;45(8):1223-6
references.pmid: 15837253
references.citation: J Appl Physiol (1985). 1985 Apr;58(4):1189-98
references.pmid: 3988674
references.citation: J Am Coll Cardiol. 1995 Mar 1;25(3):672-9
references.pmid: 7860912
references.citation: Heart. 2003 Nov;89 Suppl 3:iii18-23
references.pmid: 14594871
references.citation: Anesthesiology. 1990 Jun;72(6):966-70
references.pmid: 2190501
references.citation: Circulation. 1998 Sep 15;98(11):1071-7
references.pmid: 9736593
references.citation: Am J Cardiol. 2003 Mar 15;91(6):780-4
references.pmid: 12633827
references.citation: Am J Respir Crit Care Med. 1994 Jun;149(6):1614-8
references.pmid: 8004320
references.citation: Circulation. 2000 Jul 4;102(1):61-6
references.pmid: 10880416
references.citation: J Am Coll Cardiol. 1997 Jul;30(1):8-18
references.pmid: 9207615
references.citation: Lancet. 1999 Jun 19;353(9170):2100-5
references.pmid: 10382693
references.citation: Circulation. 1998 Jun 2;97(21):2154-9
references.pmid: 9626176
references.citation: Am Heart J. 1996 Apr;131(4):766-71
references.pmid: 8721653
references.citation: J Am Coll Cardiol. 2005 Jun 21;45(12):2008-11
references.pmid: 15963401
references.citation: Am J Respir Crit Care Med. 1995 Aug;152(2):473-9
references.pmid: 7633695
references.citation: Chest. 2003 Aug;124(2):594-601
references.pmid: 12907548
references.citation: J Appl Physiol Respir Environ Exerc Physiol. 1983 Apr;54(4):950-5
references.pmid: 6853301
references.citation: Am Rev Respir Dis. 1992 Feb;145(2 Pt 1):377-82
references.pmid: 1736745
references.citation: Lancet. 1991 Dec 14;338(8781):1480-4
references.pmid: 1683918
references.citation: J Am Soc Echocardiogr. 2005 Dec;18(12):1440-63
references.pmid: 16376782
references.citation: Am Rev Respir Dis. 1989 Nov;140(5):1257-64
references.pmid: 2573303
references.citation: Circulation. 1994 Dec;90(6):2772-9
references.pmid: 7994820
references.citation: J Am Soc Echocardiogr. 1997 Apr;10(3):246-70
references.pmid: 9109691
references.citation: Am J Respir Crit Care Med. 2004 Feb 1;169(3):361-6
references.pmid: 14597482
references.citation: Circ Res. 1986 Sep;59(3):270-82
references.pmid: 2429780
references.citation: J Am Coll Cardiol. 1997 Mar 1;29(3):604-12
references.pmid: 9060900
references.citation: J Am Soc Echocardiogr. 2002 Feb;15(2):167-84
references.pmid: 11836492
references.citation: Circulation. 2005 Jul 19;112(3):375-83
references.pmid: 16009798
references.citation: Circulation. 2003 Apr 1;107(12):1671-8
references.pmid: 12668504
references.citation: Eur Respir J. 1995 Mar;8(3):430-5
references.pmid: 7789489
references.citation: Am J Respir Crit Care Med. 1995 Jan;151(1):92-7
references.pmid: 7812579
references.citation: Circulation. 1999 Dec 7;100(23):2332-5
references.pmid: 10587337
references.citation: Am J Respir Crit Care Med. 1994 Jan;149(1):149-54
references.pmid: 8111574
references.citation: J Am Coll Cardiol. 1994 Jul;24(1):132-9
references.pmid: 8006256
references.citation: Circulation. 2000 Oct 10;102(15):1788-94
references.pmid: 11023933
references.citation: Circulation. 2002 Jan 29;105(4):539-42
references.pmid: 11815441
references.citation: Am J Respir Crit Care Med. 1999 Oct;160(4):1101-6
references.pmid: 10508793
references.citation: Circulation. 2001 May 15;103(19):2336-8
references.pmid: 11352880
references.citation: J Appl Physiol Respir Environ Exerc Physiol. 1984 Mar;56(3):619-27
references.pmid: 6368501
references.citation: Circulation. 2004 May 25;109(20):2432-9
references.pmid: 15123522
references.citation: N Engl J Med. 1981 Feb 12;304(7):387-92
references.pmid: 7005679
references.citation: Lancet. 1994 Mar 5;343(8897):572-5
references.pmid: 7906330
references.citation: J Clin Invest. 1995 Oct;96(4):1897-904
references.pmid: 7560081