Helena Glantz1, Magnus C Johansson2, Erik Thunström3, Cecilia Wallentin Guron2, Harun Uzel4, Mustafa Saygin5, Johan Herlitz6, Yüksel Peker7. 1. Dept. of Internal Medicine, Skaraborg Hospital, Lidköping, Sweden. 2. Dept. of Molecular and Clinical Medicine/Clinical Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden. 3. Dept. of Molecular and Clinical Medicine/Cardiology, Sahlgrenska Academy, University of Gothenburg, Sweden; Dept. of Cardiology, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden. 4. Dept. of Cardiology, Sahlgrenska University Hospital/Mölndal, Gothenburg, Sweden. 5. Dept. of Physiology, Faculty of Medicine, Süleyman Demirel University, Isparta, Turkey. 6. Center of Prehospital Care of Western Sweden, University College of Borås, Sweden. 7. Dept. of Molecular and Clinical Medicine/Cardiology, Sahlgrenska Academy, University of Gothenburg, Sweden; Dept. of Pulmonary Medicine, Marmara University, Istanbul, Turkey. Electronic address: yuksel.peker@marmara.edu.tr.
Abstract
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.
RCT Entities:
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.
Authors: Yinghui Gao; Yongfei Wen; Xiaoshun Qian; Libo Zhao; Hu Xu; Weihao Xu; Xiaoxuan Kong; Hebin Che; Yabin Wang; Lin Liu Journal: Nan Fang Yi Ke Da Xue Xue Bao Date: 2020-11-30