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Published ahead of print on November 3, 2003, doi:10.1164/rccm.200306-752OC

Am. J. Respir. Crit. Care Med., Volume 169, Number 3, February 2004, 361-366

A more recent version of this article appeared on February 1, 2004
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Submitted on June 16, 2003
Accepted on October 24, 2003

Controlled Trial of Continuous Positive Airway Pressure in Obstructive Sleep Apnea and Heart Failure

Darren R Mansfield1, N Claire Gollogly1, David M Kaye2, Meroula Richardson3, Peter Bergin3, and Matthew T Naughton1*

1 Respiratory Medicine, Alfred Hospital, Melbourne, Victoria, Australia; Medicine, Monash University, Melbourne, Victoria, Australia, 2 Cardiology, Alfred Hospital, Melbourne, Victoria, Australia; Baker Heart Research Institute, Melbourne, Victoria, Australia, 3 Cardiology, Alfred Hospital, Melbourne, Victoria, Australia

* To whom correspondence should be addressed. E-mail: m.naughton{at}alfred.org.au.

Obstructive sleep apnea is highly prevalent among patients with congestive heart failure and may contribute to progression of cardiac dysfunction via hypoxia, elevated sympathetic nervous system activity and systemic hypertension. Our aim was to assess the long-term effect of obstructive sleep apnea treatment with nocturnal continuous positive airway pressure (CPAP) on systolic heart function, sympathetic activity, blood pressure and quality of life in patients with congestive heart failure. Fifty-five patients with congestive heart failure and obstructive sleep apnea were randomised to 3 months of CPAP or control groups. End-points were changes in left ventricular ejection fraction, overnight urinary norepinephrine excretion, blood pressure and quality of life. Nineteen patients in the CPAP group and 21 control subjects completed the study. Compared with the control group, CPAP treatment was associated with significant improvements in left ventricular ejection fraction ({Delta} 1.5±1.4 vs 5.0±1.0% respectively, p=0.04) , reductions in overnight urinary norepinephrine excretion ({Delta} 1.6±3.7 vs -9.9±3.6 nmol/mmol creatinine, p=0.036), and improvements in quality of life. There were no significant changes in systemic blood pressure. In conclusion, treatment of obstructive sleep apnea among patients with congestive heart failure leads to improvement in cardiac function, sympathetic activity and quality of life.
Key words: congestive heart failure, obstructive sleep apnea, continuous positive airway pressure




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