Published online before print July 11, 2005, doi: 10.1161/CIRCULATIONAHA.104.501841
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(Circulation. 2005;112:375-383.)
© 2005 American Heart Association, Inc.
Heart Failure |
Obstructive Sleep Apnea Syndrome Affects Left Ventricular Diastolic Function
Effects of Nasal Continuous Positive Airway Pressure in Men
From Servicios de Cardiología (M.A.A.) and Neumología (F.G.-R., A.A.-F., O.M., J.V.) and Laboratorio de Bioquímica (I.M.), Hospital Universitario La Paz, Madrid, Spain.
Correspondence to Dr Francisco García-Río, c/Alfredo Marqueríe 11, izqda, 1°A, 28034 Madrid, Spain. E-mail fgr01m{at}jazzfree.com
Received September 13, 2004; revision received March 19, 2005; accepted April 11, 2005.
Background— The purpose of this study was to determine the role of obstructive sleep apnea syndrome (OSAS) as an independent risk factor for the development of left ventricular diastolic abnormalities. Moreover, we tested the hypothesis that nasal continuous positive airway pressure (nCPAP) improves such alterations in OSAS patients by eliminating apneic events.
Methods and Results— In this prospective, randomized, placebo-controlled, double-blind crossover study, 27 consecutive newly diagnosed middle-aged OSAS men with neither controllable factors nor conditions affecting left ventricular diastolic function and 15 healthy control subjects were selected. OSAS patients were randomized to 12 weeks on sham nCPAP and 12 weeks on effective nCPAP application. Echocardiographic parameters, blood pressure recordings, and urinary catecholamine levels were obtained at baseline and after both treatment modalities. At baseline, an abnormal left ventricular filling pattern was present in 15 of the 27 OSAS patients and only in 3 of the 15 control subjects (P=0.020). Impaired relaxation was by far the most common abnormal pattern in both groups (11 and 3 patients, respectively). In OSAS patients, 12 weeks on effective nCPAP induced a significant increase in E/A ratio (P<0.01), as well as reductions in mitral deceleration (P<0.01) and isovolumic relaxation (P<0.05) times.
Conclusions— OSAS can affect left ventricular diastolic function independently of other possible factors. Chronic application of nCPAP could avoid the progression of diastolic abnormalities, and indeed, it might reverse these alterations, at least in the initial stages before severe structural changes can be developed.
Key Words: physiology • echocardiography • diastole • pulmonary heart disease • sleep
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