title: Impact of Continuous Positive Airway Pressure Therapy on Atrial Electromechanical Delay in Obesity-Hypoventilation Syndrome Patients.
abstract: BACKGROUND
  Obesity-hypoventilation syndrome (OHS) is defined as daytime hypercapnia and hypoxemia in obese patients with sleep-disordered breathing. We evaluated the electrocardiographic P-wave duration and dispersion (PD) and echocardiographic noninvasive indicators of atrial conduction heterogeneity in OHS patients and the impact of CPAP on atrial conduction and atrial fibrillation incidence.
  
  
  RESULTS
  We enrolled 50 OHS patients and 50 sex- and age-matched obese subjects as control. Study population underwent cardiologic evaluation and polysomnography before enrollment, at 1- and 6-month follow-ups after CPAP therapy. The OHS group showed a significant increase in inter-atrial (35.2 ± 8 milliseconds vs. 20.1 ± 2.7 milliseconds, P < 0.0001), intra-left (30.5 ± 7.2 milliseconds vs. 16.5 ± 2 milliseconds, P < 0.0001), and intra-right atrial electromechanical delays (AEMD)(24.8 ± 10 milliseconds vs. 15 ± 2.6 milliseconds, P < 0.0001) as well as in Pmax (130 ± 7.4 milliseconds vs. 97 ± 7.2 milliseconds, P = 0.002) and PD (56.5 ± 8.5 milliseconds vs. 31 ± 7.2 milliseconds, P = 0.002) compared to the control group. Significant improvement was noted after 6 months of CPAP therapy in inter-atrial (35.2 ± 8 milliseconds vs. 24.5 ± 6.3 milliseconds, P < 0.0001), intra-left (30.5 ± 7.2 milliseconds vs. 20.6 ± 5 milliseconds, P = 0.003), and intra-right AEMD (24.8 ± 10 milliseconds vs. 17 ± 7.5 milliseconds, P < 0.0001), as well as in Pmax (130 ± 7.4 milliseconds vs. 95 ± 10 milliseconds, P < 0.0001) and in PD (56.5 ± 8.5 milliseconds vs. 32.5 ± 6 milliseconds, P < 0.0001) in the OHS group. External loop recorder monitoring detected paroxysmal AF in 19 OHS patients (38%) with significant reduction in paroxysmal AF episodes (12 ± 6 vs. 47 ± 12, P < 0.0001) after 6-month CPAP therapy.
  
  
  CONCLUSIONS
  Our findings showed a significant increase of electrocardiographic and echocardiographic indexes of atrial conduction heterogeneity in OHS patients. The CPAP therapy, having a positive impact on atrial conduction time, seems to reduce AF incidence in OHS patients.
authors.affiliation: Chair of Cardiology, Second University of Naples, AORN dei Colli-Monaldi Hospital, Naples, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Russo
authors.affiliation: Chair of Cardiology, Second University of Naples, AORN dei Colli-Monaldi Hospital, Naples, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Di Meo
authors.affiliation: Chair of Cardiology, Second University of Naples, AORN dei Colli-Monaldi Hospital, Naples, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Rago
authors.affiliation: Division of Pneumology, Department of Respiratory Diseases, University of Naples Federico II, AORN dei Colli-Monaldi Hospital, Naples, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Mosella
authors.affiliation: Division of Pneumology, Department of Respiratory Diseases, University of Naples Federico II, AORN dei Colli-Monaldi Hospital, Naples, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Molino
authors.affiliation: Chair of Cardiology, Second University of Naples, AORN dei Colli-Monaldi Hospital, Naples, Italy.
authors.forename: Maria Giovanna
authors.initials: MG
authors.lastname: Russo
authors.affiliation: Chair of Cardiology, Second University of Naples, AORN dei Colli-Monaldi Hospital, Naples, Italy.
authors.forename: Gerardo
authors.initials: G
authors.lastname: Nigro
mesh_terms: D000328:Adult; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging* / Q000503:physiopathology* / Q000628:therapy; D016279:Atrial Function, Left / Q000502:physiology*; D015331:Cohort Studies; D045422:Continuous Positive Airway Pressure / Q000379:methods*; D004452:Echocardiography; D004562:Electrocardiography / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010845:Obesity Hypoventilation Syndrome / Q000000981:diagnostic imaging* / Q000503:physiopathology* / Q000628:therapy; D016037:Single-Blind Method; D013997:Time Factors; D018615:Ultrasonography, Doppler, Color
keywords: CPAP therapy; P-wave dispersion; atrial electromechanic delays; obesity hypoventilation syndrome