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Published ahead of print on November 3, 2003, doi:10.1164/rccm.200306-752OC
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American Journal of Respiratory and Critical Care Medicine Vol 169. pp. 361-366, (2004)
© 2004 American Thoracic Society

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

Darren R. Mansfield, N. Claire Gollogly, David M. Kaye, Meroula Richardson, Peter Bergin and Matthew T. Naughton

Departments of Respiratory Medicine and Cardiology, Alfred Hospital, Monash University; and Baker Heart Research Institute, Melbourne, Australia

Correspondence and requests for reprints should be addressed to Matthew T. Naughton, M.D., Department of Respiratory Medicine, Alfred Hospital, Commercial Road, Melbourne, Victoria 3181, Australia. E-mail: m.naughton{at}alfred.org.au

Obstructive sleep apnea (OSA) is highly prevalent among patients with congestive heart failure (CHF) 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 OSA treatment with nocturnal continuous positive airway pressure (CPAP) on systolic heart function, sympathetic activity, blood pressure, and quality of life in patients with CHF. Fifty-five patients with CHF and OSA were randomized 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 OSA among patients with CHF 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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