Cardiac Effects of Continuous and Bi-level Positive Airway Pressure for Patients with Heart Failure and Obstructive Sleep Apnea: A Pilot Study.
Chest. 2008 Jul 18;
Authors: Khayat RN, Abraham WT, Patt B, Roy M, Hua K, Jarjoura D
Background Obstructive Sleep Apnea (OSA) is prevalent in patients with heart failure. Treatment with Continuous Positive Airway Pressure (CPAP) improves systolic function in patients with heart failure. Bi-level Positive Airway Pressure (Bilevel PAP) is another treatment modality for OSA. The intermediate term effect of bilevel PAP on left ventricular ejection fraction in patients with stable heart failure and OSA has not been compared to the effect of CPAP. Methods In this pilot randomized controlled trial, patients with stable systolic dysfunction and newly diagnosed OSA (n=24) were randomized to receive either CPAP or bilevel PAP. Titration was done in the Sleep laboratory using CPAP based algorithm. Primary outcome was the improvement in left ventricular ejection fraction (LVEF) after 3 months of treatment. Other measurements included: 6 minute walk test, Epworth Sleepiness Scale and Living with heart failure Minnesota Questionnaire. Results Bilevel PAP increased LVEF 7.9 (LVEF percent scale) more than CPAP ((95% CI, 2.3, 13.4, P= 0.01). In the bilevel PAP group, LVEF increased 8.5% (95% CI 3.7, 13.4 P 0.002). In the CPAP group, LVEF did not change significantly (0.5% (95% CI -2.7, 3.7 p 0.7). The difference in LVEF improvement between the two groups was still significant after adjustment for adherence, level of treatment positive pressure, body mass index, and severity of OSA. Conclusion This pilot randomized controlled trial suggests that bilevel PAP is superior to CPAP in improving LVEF in patients with systolic dysfunction and OSA. Larger trials are required to evaluate the mechanism behind this effect.
PMID: 18641111 [PubMed - as supplied by publisher]