title: Effect of CPAP on Cardiac Function in Minimally Symptomatic Patients with OSA: Results from a Subset of the MOSAIC Randomized Trial.
abstract: OBJECTIVE
  Minimally symptomatic obstructive sleep apnea (OSA) is highly prevalent, and the effects of continuous positive airway pressure (CPAP) on myocardial function in these patients are unknown. The MOSAIC randomized, controlled trial of CPAP for minimally symptomatic OSA assessed the effect of CPAP on myocardial function in a subset of patients.
  
  
  METHODS
  Two centers taking part in the MOSAIC trial randomized 238 patients in parallel to 6 months of CPAP (120) or standard care (118). Of these, 168 patients had echocardiograms, and 68 patients had a cardiac magnetic resonance scan (CMR). A larger group (314) from 4 centers had brain natriuretic peptide (BNP) measured.
  
  
  RESULTS
  Mean (SD) baseline oxygen desaturation index (ODI) and Epworth sleepiness score (ESS) were 13.5 (13.2), and 8.4 (4.0), respectively. CPAP significantly reduced ESS and ODI. Baseline LV ejection fraction (LVEF) was well preserved (60.4%). CPAP had no significant effect on echo-derived left atrial (LA) area (-1.0 cm2, 95% CI -2.6 to +0.6, p = 0.23) or early to late left ventricular filling velocity (E/A) ratio (-0.01, 95% CI -0.07 to +0.05, p = 0.79). There was a small change in echo-derived LV end diastolic volume (EDV) with CPAP (-5.9 mL, 95% CI -10.6 to -1.2, p = 0.015). No significant changes were detected by CMR on LV mass index (+1.1 g/m(2), 95% CI -5.9 to +8.0, p = 0.76) or LVEF (+0.8%, 95% CI -1.2 to +2.8, p = 0.41). CPAP did not affect BNP levels (p = 0.16).
  
  
  CONCLUSIONS
  Six months of CPAP therapy does not change cardiac functional or structural parameters measured by echocardiogram or CMR in patients with minimally symptomatic mild-to-moderate OSA.
  
  
  BACKGROUND
  ISRCTN 34164388 (http://isrctn.org).
authors.affiliation: Oxford Centre for Respiratory Medicine, Oxford Biomedical Research Centre and Oxford University, Oxford, UK.
authors.forename: Sonya
authors.initials: S
authors.lastname: Craig
authors.affiliation: Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK.
authors.forename: Ilias
authors.initials: I
authors.lastname: Kylintireas
authors.affiliation: Sleep Unit Disorders Center and Pulmonary Division University Hospital Zurich, Zurich, Switzerland.
authors.forename: Malcolm
authors.initials: M
authors.lastname: Kohler
authors.affiliation: Oxford Centre for Respiratory Medicine, Oxford Biomedical Research Centre and Oxford University, Oxford, UK.
authors.forename: Debby
authors.initials: D
authors.lastname: Nicoll
authors.affiliation: Sleep Unit Disorders Center and Pulmonary Division University Hospital Zurich, Zurich, Switzerland.|Medical Research Council Clinical Trials Unit at University College London, London, UK.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Bratton
authors.affiliation: Medical Research Council Clinical Trials Unit at University College London, London, UK.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Nunn
authors.affiliation: Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Leeson
authors.affiliation: Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK.
authors.forename: Stefan
authors.initials: S
authors.lastname: Neubauer
authors.affiliation: Oxford Centre for Respiratory Medicine, Oxford Biomedical Research Centre and Oxford University, Oxford, UK.
authors.forename: John R
authors.initials: JR
authors.lastname: Stradling
mesh_terms: D045422:Continuous Positive Airway Pressure / Q000706:statistics & numerical data*; D005260:Female; D006321:Heart / Q000503:physiopathology; D006331:Heart Diseases / Q000150:complications* / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020181:Sleep Apnea, Obstructive / Q000150:complications* / Q000628:therapy*; D016896:Treatment Outcome
keywords: CPAP; echocardiography; magnetic resonance scanning; myocardial function; obstructive sleep apnea