This Article Full Text Full Text (PDF) List of Investigators All Versions of this Article: 115/25/3173    most recent CIRCULATIONAHA.106.683482v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Arzt, M. Search for Related Content PubMed PubMed Citation Articles by Arzt, M. Related Collections Congestive Other Treatment

(Circulation. 2007;115:3173-3180.)
© 2007 American Heart Association, Inc.

Heart Failure

Suppression of Central Sleep Apnea by Continuous Positive Airway Pressure and Transplant-Free Survival in Heart Failure

A Post Hoc Analysis of the Canadian Continuous Positive Airway Pressure for Patients With Central Sleep Apnea and Heart Failure Trial (CANPAP)

Michael Arzt, MD; John S. Floras, MD, DPhil; Alexander G. Logan, MD; R. John Kimoff, MD; Frederic Series, MD; Debra Morrison, MD; Kathleen Ferguson, MD; Israel Belenkie, MD; Michael Pfeifer, MD; John Fleetham, MD; Patrick Hanly, MD; Mark Smilovitch, MD; Clodagh Ryan, MD; George Tomlinson, PhD; T. Douglas Bradley, MD, for the CANPAP Investigators

From the University of Toronto (M.A., J.S.F., A.G.L., P.H., C.R., G.T., T.D.B.), Toronto, Ontario, Canada; University of British Columbia (J.F.), Vancouver, British Columbia, Canada; University of Calgary (I.B., P.H.), Calgary, Alberta, Canada; University of Western Ontario (K.F.), London, Ontario, Canada; McGill University (R.J.K., M.S.), Montreal, Quebec, Canada; Laval University (F.S.), Quebec City, Quebec, Canada; Dalhousie University (D.M.), Halifax, Nova Scotia, Canada; and the University of Regensburg (M.P.), Regensburg, Germany.

Correspondence to T. Douglas Bradley, MD, Toronto General Hospital/University Health Network, 9N-943, 200 Elizabeth St, Toronto, Ontario, M5G 2C4, Canada. E-mail douglas.bradley{at}utoronto.ca

Received December 11, 2006; accepted April 9, 2007.

Background— In the main analysis of the Canadian Continuous Positive Airway Pressure (CPAP) for Patients with Central Sleep Apnea (CSA) and Heart Failure Trial (CANPAP), CPAP had no effect on heart transplant–free survival; however, CPAP only reduced the mean apnea-hypopnea index to 19 events per hour of sleep, which remained above the trial inclusion threshold of 15. This stratified analysis of CANPAP tested the hypothesis that suppression of CSA below this threshold by CPAP would improve left ventricular ejection fraction and heart transplant–free survival.

Methods and Results— Of the 258 heart failure patients with CSA in CANPAP, 110 of the 130 randomized to the control group and 100 of the 128 randomized to CPAP had sleep studies 3 months later. CPAP patients were divided post hoc into those whose apnea-hypopnea index was or was not reduced below 15 at this time (CPAP-CSA suppressed, n=57, and CPAP-CSA unsuppressed, n=43, respectively). Their changes in left ventricular ejection fraction and heart transplant–free survival were compared with those in the control group. Despite similar CPAP pressure and hours of use in the 2 groups, CPAP-CSA–suppressed subjects experienced a greater increase in left ventricular ejection fraction at 3 months (P=0.001) and significantly better transplant-free survival (hazard ratio [95% confidence interval] 0.371 [0.142 to 0.967], P=0.043) than control subjects, whereas the CPAP-CSA–unsuppressed group did not (for left ventricular ejection fraction, P=0.984, and for transplant-free survival, hazard ratio 1.463 [95% confidence interval 0.751 to 2.850], P=0.260).

Conclusions— These results suggest that in heart failure patients, CPAP might improve both left ventricular ejection fraction and heart transplant–free survival if CSA is suppressed soon after its initiation.

---

 

CLINICAL PERSPECTIVE

This article has been cited by other articles:

				J S Floras Should sleep apnoea be a specific target of therapy in chronic heart failure? Heart, July 1, 2009; 95(13): 1041 - 1046. [Abstract] [Full Text] [PDF]

				D Yumino, H Wang, J S Floras, G E Newton, S Mak, P Ruttanaumpawan, J D Parker, and T D Bradley Relationship between sleep apnoea and mortality in patients with ischaemic heart failure Heart, May 1, 2009; 95(10): 819 - 824. [Abstract] [Full Text] [PDF]

				L. Luthje, B. Renner, R. Kessels, D. Vollmann, T. Raupach, B. Gerritse, S. Tasci, J. O. Schwab, M. Zabel, D. Zenker, et al. Cardiac resynchronization therapy and atrial overdrive pacing for the treatment of central sleep apnoea Eur J Heart Fail, March 1, 2009; 11(3): 273 - 280. [Abstract] [Full Text] [PDF]

				G. D. Pinna, R. Maestri, A. Mortara, P. Johnson, D. Andrews, P. Ponikowski, T. Witkowski, E. Robbi, M. T. La Rovere, and P. Sleight Pathophysiological and clinical relevance of simplified monitoring of nocturnal breathing disorders in heart failure patients Eur J Heart Fail, March 1, 2009; 11(3): 264 - 272. [Abstract] [Full Text] [PDF]

				V. K. Somers, D. P. White, R. Amin, W. T. Abraham, F. Costa, A. Culebras, S. Daniels, J. S. Floras, C. E. Hunt, L. J. Olson, et al. Sleep Apnea and Cardiovascular Disease: An American Heart Association/American College of Cardiology Foundation Scientific Statement From the American Heart Association Council for High Blood Pressure Research Professional Education Committee, Council on Clinical Cardiology, Stroke Council, and Council on Cardiovascular Nursing In Collaboration With the National Heart, Lung, and Blood Institute National Center on Sleep Disorders Research (National Institutes of Health) Circulation, September 2, 2008; 118(10): 1080 - 1111. [Full Text] [PDF]

				L. K. Brown Filling in the Gaps: The Role of Noninvasive Adaptive Servoventilation for Heart Failure-Related Central Sleep Apnea Chest, July 1, 2008; 134(1): 4 - 7. [Full Text] [PDF]

				M. Arzt, R. Wensel, S. Montalvan, T. Schichtl, S. Schroll, S. Budweiser, F. C. Blumberg, G. A. J. Riegger, and M. Pfeifer Effects of Dynamic Bilevel Positive Airway Pressure Support on Central Sleep Apnea in Men With Heart Failure Chest, July 1, 2008; 134(1): 61 - 66. [Abstract] [Full Text] [PDF]

				A. K. Simonds and M. R. Cowie Taboo: crossing the specialty barrier Eur. Respir. J., June 1, 2008; 31(6): 1153 - 1154. [Full Text] [PDF]

				O. Oldenburg, A. Schmidt, B. Lamp, T. Bitter, B. G. Muntean, C. Langer, and D. Horstkotte Adaptive servoventilation improves cardiac function in patients with chronic heart failure and Cheyne-Stokes respiration Eur J Heart Fail, June 1, 2008; 10(6): 581 - 586. [Abstract] [Full Text] [PDF]

				R. L. Horner and T. D. Bradley Update in Sleep and Control of Ventilation 2007 Am. J. Respir. Crit. Care Med., May 1, 2008; 177(9): 947 - 951. [Full Text] [PDF]

				B. Phillips Improving Access to Diagnosis and Treatment of Sleep-Disordered Breathing Chest, November 1, 2007; 132(5): 1418 - 1420. [Full Text] [PDF]