Khayat Rami N, Abraham William T, Patt Brian, Roy Monica, Hua Keding, Jarjoura David
Sleep-Heart Program, The Ohio Sate University, Columbus, OH.
Division of Cardiovascular Medicine, The Ohio Sate University, Columbus, OH.
Chest. 2008 Dec;134(6):1162-1168. doi: 10.1378/chest.08-0346. Epub 2008 Jul 18.
Obstructive sleep apnea (OSA) is prevalent in patients with heart failure. Treatment with continuous positive airway pressure (CPAP) improves systolic function in patients with heart failure. Bilevel positive airway pressure (PAP) is another treatment modality for OSA. The intermediate-term effect of bilevel PAP on left ventricular ejection fraction (LVEF) in patients with stable heart failure and OSA has not been compared to the effect of CPAP.
In this pilot randomized controlled trial, patients with stable systolic dysfunction and newly diagnosed OSA (n = 24) were randomized to receive either CPAP or bilevel PAP. Titration was done in the sleep laboratory using a CPAP-based algorithm. Primary outcome was the improvement in LVEF after 3 months of treatment. Other measurements included 6-min walk test, Epworth sleepiness scale score, and the Minnesota Living With Heart Failure questionnaire.
Bilevel PAP increased LVEF 7.9% (LVEF percentage scale) more than CPAP (95% confidence interval [CI], 2.3 to 13.4; p = 0.01). In the bilevel PAP group, LVEF increased 8.5% (95% CI, 3.7 to 13.4; p = 0.002). In the CPAP group, LVEF did not change significantly (0.5%; 95% CI, - 2.7 to 3.7; p = 0.7). The difference in LVEF improvement between the two groups was still significant after adjustment for adherence, level of treatment positive pressure, body mass index, and severity of OSA.
This pilot randomized controlled trial suggests that bilevel PAP is superior to CPAP in improving LVEF in patients with systolic dysfunction and OSA. Larger trials are required to evaluate the mechanism behind this effect.
阻塞性睡眠呼吸暂停（OSA）在心力衰竭患者中很常见。持续气道正压通气（CPAP）治疗可改善心力衰竭患者的收缩功能。双水平气道正压通气（PAP）是治疗OSA的另一种方式。双水平PAP对稳定型心力衰竭合并OSA患者左心室射血分数（LVEF）的中期影响尚未与CPAP的效果进行比较。
在这项初步随机对照试验中，将稳定型收缩功能障碍和新诊断为OSA的患者（n = 24）随机分为接受CPAP或双水平PAP治疗。使用基于CPAP的算法在睡眠实验室进行滴定。主要结局是治疗3个月后LVEF的改善情况。其他测量指标包括6分钟步行试验、爱泼华嗜睡量表评分和明尼苏达心力衰竭生活问卷。
双水平PAP使LVEF提高的幅度比CPAP高7.9%（LVEF百分比量表）（95%置信区间[CI]，2.3至13.4；p = 0.01）。在双水平PAP组中，LVEF提高了8.5%（95% CI，3.7至13.4；p = 0.002）。在CPAP组中，LVEF无显著变化（0.5%；95% CI，-2.7至3.7；p = 0.7）。在对依从性、治疗正压水平、体重指数和OSA严重程度进行调整后，两组之间LVEF改善的差异仍然显著。
这项初步随机对照试验表明，在改善收缩功能障碍合并OSA患者LVEF方面，双水平PAP优于CPAP。需要进行更大规模的试验来评估这种效果背后的机制。
