Cardiovascular Effects of Continuous Positive Airway Pressure in Patients with Heart Failure and Obstructive Sleep Apnea

doi:10.1056/NEJMoa022479

Volume 348:1233-1241		March 27, 2003		Number 13

Cardiovascular Effects of Continuous Positive Airway Pressure in Patients with Heart Failure and Obstructive Sleep Apnea

Yasuyuki Kaneko, M.D., John S. Floras, M.D., D.Phil., Kengo Usui, M.D., Ph.D., Julie Plante, M.D., Ruzena Tkacova, M.D., Ph.D., Toshihiko Kubo, M.D., Ph.D., Shin-ichi Ando, M.D., Ph.D., and T. Douglas Bradley, M.D.

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ABSTRACT

Background Obstructive sleep apnea subjects the failing heartto adverse hemodynamic and adrenergic loads and may therebycontribute to the progression of heart failure. We hypothesizedthat treatment of obstructive sleep apnea by continuous positiveairway pressure in patients with heart failure would improveleft ventricular systolic function.

Methods Twenty-four patients with a depressed left ventricularejection fraction (45 percent or less) and obstructive sleepapnea who were receiving optimal medical treatment for heartfailure underwent polysomnography. On the following morning,their blood pressure and heart rate were measured by digitalphotoplethysmography, and left ventricular dimensions and leftventricular ejection fraction were assessed by echocardiography.The subjects were then randomly assigned to receive medicaltherapy either alone (12 patients) or with the addition of continuouspositive airway pressure (12 patients) for one month. The assessmentprotocol was then repeated.

Results In the control group of patients who received only medicaltherapy, there were no significant changes in the severity ofobstructive sleep apnea, daytime blood pressure, heart rate,left ventricular end-systolic dimension, or left ventricularejection fraction during the study. In contrast, continuouspositive airway pressure markedly reduced obstructive sleepapnea, reduced the daytime systolic blood pressure from a mean(±SE) of 126±6 mm Hg to 116±5 mm Hg (P=0.02),reduced the heart rate from 68±3 to 64±3 beatsper minute (P=0.007), reduced the left ventricular end-systolicdimension from 54.5±1.8 to 51.7±1.2 mm (P=0.009),and improved the left ventricular ejection fraction from 25.0±2.8to 33.8±2.4 percent (P<0.001).

Conclusions In medically treated patients with heart failure,treatment of coexisting obstructive sleep apnea by continuouspositive airway pressure reduces systolic blood pressure andimproves left ventricular systolic function. Obstructive sleepapnea may thus have an adverse effect in heart failure thatcan be addressed by targeted therapy.

Source Information

From the Sleep Research Laboratories, Toronto Rehabilitation Institute (Y.K., K.U., J.P., R.T., T.D.B.); Toronto General Hospital–University Health Network and Mount Sinai Hospital (J.S.F., T.K., S.A., T.D.B.); and the Department of Medicine and the Centre for Sleep Medicine and Circadian Biology, University of Toronto (Y.K., J.S.F., K.U., J.P., R.T., T.D.B.) — all in Toronto.

Address reprint requests to Dr. Bradley at the Toronto General Hospital/UHN, NU 9-112, 200 Elizabeth St., Toronto, ON M5G 2C4, Canada, or at douglas.bradley{at}utoronto.ca.

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Continuous Positive Airway Pressure in Patients with Heart Failure
Tulaimat A., Mokhlesi B., Stevens D., Weinstein M. D., Bradley T. D., Floras J. S., Usui K.
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N Engl J Med 2003; 349:93-95, Jul 3, 2003. Correspondence

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