What is the clinical evidence from this study?

Study design: Cohort. Population: Obstructive sleep apnea (OSA) (n=82). Intervention: Continuous positive airway pressure (CPAP) vs. Baseline (pre-treatment). Primary outcome: Left ventricular ejection fraction (LVEF) (p=<0.0001).

October 11, 2013Open Access

Impact of Untreated Obstructive Sleep Apnea on Left and Right Ventricular Myocardial Function and Effects of CPAP Therapy

Q: What are the key findings of this study?

Six months of CPAP therapy significantly improved left ventricular ejection fraction and apical right ventricular longitudinal strain in patients with obstructive sleep apnea.

CHChristoph HammerstinglInterventional Cardiology RSRobert SchuelerSt. Michael's Hospital MWMartin H. J. WiesenUniversity of Cologne

Key Result

Six months of CPAP therapy significantly improved left ventricular ejection fraction and apical right ventricular longitudinal strain in patients with obstructive sleep apnea.

Study Design

Type

Cohort (n=82)

Multicenter

Structured PICO

Does continuous positive airway pressure (CPAP) therapy improve left and right ventricular function in patients with obstructive sleep apnea?

Population

82 patients with obstructive sleep apnea (OSA) and need for continuous positive airway pressure (CPAP) therapy, mean age 63.3 years, 63.4% male, based in Germany.

Intervention

Continuous positive airway pressure (CPAP) therapy for 6 months.

Outcome

Prevalence of echocardiographically detectable pathologic myocardial left and right ventricular functional parameters before CPAP therapy, and evaluation of changes in measurable LV/RV functional parameters after 6 months of OSA therapy with CPAP.surrogate

CPAP therapy significantly improves left and right ventricular function, particularly in patients with severe obstructive sleep apnea.

Main Result

Absolute Event Rate: 63.2% vs 60.7%

p-value: p=<0.0001

Limitations

Not randomized
Not blinded
Single center study
Small sample size
Presence of cardiovascular comorbidities at baseline could confound results
Observational design

Abstract

BACKGROUND: Obstructive sleep apnea (OSA) has deteriorating effect on LV function, whereas its impact on RV function is controversial. We aimed to determine the effect of OSA and continuous positive airway pressure (CPAP) treatment on left and right ventricular (LV, RV) function using transthoracic echocardiography (TTE) and 2 dimensional speckle tracking (2D ST) analysis of RV deformation capability. METHODS AND RESULTS: 82 patients with OSA and need for CPAP therapy were prospectively enrolled and underwent TTE at study inclusion and after 6 months of follow up (FU). Multivariate regression analysis revealed an independent association between baseline apical right ventricular longitudinal strain (RV-Sl), BMI and the severity of OSA (apical RV-Sl: P = 0.0002, BMI: P = 0.02). After CPAP therapy, LV functional parameters (LVEF: P30:54.1 ± 12.4%, 68.2 ± 13.6%P30: -6.3 ± 5.7%, -17.9 ± 11.2% [P<0.0001). CONCLUSIONS: OSA seems to have deteriorating effect on LV and RV function. We found a beneficial effect of CPAP on LV and RV functional parameters predominately in patients with severe OSA. 2D speckle tracking might be of value to determine early changes in global and regional right ventricular function.

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