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Effect of CPAP on diastolic function in coronary artery disease patients with nonsleepy obstructive sleep apnea: A
Helena Glantz1, Magnus C Johansson2, Erik Thunström3
1Dept. of Internal Medicine, Skaraborg Hospital, Lidköping, Sweden.
Insights
Continuous positive airway pressure (CPAP) did not improve diastolic function in coronary artery disease (CAD) patients with obstructive sleep apnea (OSA). However, good CPAP adherence showed benefits for diastolic relaxation velocity.
Area of Science:
- Cardiology
- Sleep Medicine
- Pulmonology
Background:
- Obstructive sleep apnea (OSA) is linked to impaired diastolic function in coronary artery disease (CAD) patients.
- Nonsleepy OSA patients with CAD require investigation into treatment effects on diastolic function.
Purpose of the Study:
- To determine if continuous positive airway pressure (CPAP) improves diastolic function in CAD patients with nonsleepy OSA.
- To assess the impact of CPAP on echocardiographic parameters of diastolic function.
Main Methods:
- A randomized controlled trial involving 244 revascularized CAD patients with nonsleepy OSA (apnea-hypopnea index ≥15/h, Epworth Sleepiness Scale <10).
- Patients were assigned to CPAP or no-CPAP, with echocardiography at baseline, 3, and 12 months.
- 171 patients with preserved ejection fraction and adequate echocardiograms were included in the analysis.
Main Results:
- CPAP treatment showed no significant improvement in mild or worse diastolic dysfunction parameters in the intention-to-treat analysis.
- Post-hoc analysis indicated a significant association between CPAP usage (≥4h/night) and increased diastolic relaxation velocity at 12 months.
- This association remained significant after adjusting for baseline clinical and echocardiographic variables.
Conclusions:
- CPAP therapy does not significantly improve diastolic dysfunction in nonsleepy OSA patients with CAD.
- However, consistent CPAP adherence (≥4 hours/night) was associated with improved diastolic relaxation velocity after one year.
Background:
Obstructive sleep apnea (OSA) has been associated with worse diastolic function in patients with coronary artery disease (CAD). This analysis determined whether continuous positive airway pressure (CPAP) treatment would improve diastolic function in CAD patients with nonsleepy OSA.
Methods:
Between December 2005 and November 2010, 244 revascularized CAD patients with nonsleepy OSA (apnea-hypopnea index (AHI) ≥15/h, Epworth Sleepiness Scale [ESS] score<10) were randomly assigned to CPAP or no-CPAP. Echocardiographic measurements were obtained at baseline, and after 3 and 12months.
Results:
A total of 171 patients with preserved left ventricular ejection fraction (≥50%), no atrial fibrillation or severe valve abnormalities, and technically adequate echocardiograms at baseline and follow-up visits were included (CPAP, n=87; no-CPAP, n=84). In the intention-to-treat analysis, CPAP had no significant effect on echocardiographic parameters of mild (enlarged left atrium or decreased diastolic relaxation velocity) or worse (increased E/é filling index [presumed elevated left ventricular filling pressure]) diastolic function. Post-hoc analysis revealed a significant association between CPAP usage for ≥4h/night and an increase in diastolic relaxation velocity at 12months' follow-up (odds ratio 2.3, 95% confidence interval 1.0-4.9; p=0.039) after adjustment for age, sex, body mass index, and left atrium diameter at baseline.
Conclusions:
CPAP did not improve diastolic dysfunction in CAD patients with nonsleepy OSA. However, good CPAP adherence was significantly associated with an increase in diastolic relaxation velocity after one year.