title: Effective sleep apnoea treatment improves cardiac function in patients with chronic heart failure.
abstract: BACKGROUND
  Sleep disordered breathing (SDB) is highly prevalent in patients with chronic heart failure (CHF) and is associated with adverse effects on cardiac geometry and function. Continuous positive airway pressure (CPAP) has been proved an effective treatment modality for obstructive sleep apnoea (OSA), whereas adaptive servoventilation (ASV) is more effective in patients with central sleep apnoea (CSA). The impact of selection of therapy and effective apnoea alleviation on cardiac performance and reverse left ventricular remodelling (r-LVR) has not yet been evaluated.
  
  
  METHODS
  Eighty five patients with stable CHF were screened for SDB and underwent polysomnography and treatment according to the type of SDB. Clinical evaluation and a comprehensive echocardiographic study was performed before initiation of therapy and after six months of effective treatment (ventilator use >5h/day with AHI <5 events/h).
  
  
  RESULTS
  Seventeen compliant patients under effective treatment were included in the analysis (8 OSA under Autoset CPAP and 9 CSA under ASV). In both groups, a significant improvement in all measured, conventional and TDI LV systolic indexes was recorded, including LVEF (32% ± 6% vs. 27% ± 6%, p<0.001). A decrease in LV end-systolic volume (189 ± 94 ml vs. 211 ± 88 ml, p=0.015, difference >10%) was indicative of r-LVR. Furthermore, RV systolic parameters were also increased (TAPSE, p<0.001; systolic TDI wave from lateral tricuspid annular aspect, p=0.001), whereas right heart dimensions and areas were diminished, indicating better pulmonary haemodynamics. Moreover, a significant improvement in patients' clinical status, as evaluated by New York Heart Association Class was also documented at the end of six months follow-up.
  
  
  CONCLUSIONS
  Effective alleviation of SDB in CHF patients is associated with significant improvements in LV and RV systolic function and r-LVR. Longitudinal studies are needed to evaluate effects on morbidity and mortality.
authors.affiliation: 1st Department of Cardiology, "Korgialenio-Benakio", Red Cross Hospital of Athens, Greece.
authors.forename: Spiros P
authors.initials: SP
authors.lastname: Kourouklis
authors.forename: Emmanouil
authors.initials: E
authors.lastname: Vagiakis
authors.forename: Ioannis A
authors.initials: IA
authors.lastname: Paraskevaidis
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Farmakis
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Kostikas
authors.forename: John T
authors.initials: JT
authors.lastname: Parissis
authors.forename: Apostolos
authors.initials: A
authors.lastname: Katsivas
authors.forename: Dimitrios T
authors.initials: DT
authors.lastname: Kremastinos
authors.forename: Maria
authors.initials: M
authors.lastname: Anastasiou-Nana
authors.forename: Gerasimos
authors.initials: G
authors.lastname: Filippatos
mesh_terms: D000368:Aged; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017286:Polysomnography / Q000379:methods; D012891:Sleep Apnea Syndromes / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy*; D013318:Stroke Volume / Q000502:physiology*; D016896:Treatment Outcome