Oliveira W, Campos O, Cintra F, Matos L, Vieira M L C, Rollim B, Fujita L, Tufik S, Poyares D
Discipline of Sleep Biology and Medicine, Department of Psychobiology, Federal University of Sao Paulo, Sao Paulo, Brazil.
Heart. 2009 Nov;95(22):1872-8. doi: 10.1136/hrt.2009.173625. Epub 2009 Jul 29.
Obstructive sleep apnoea (OSA) has been reported as a predictor of left ventricle (LV) diastolic dysfunction and left atrium (LA) remodelling. The aim of this study is to evaluate the impact of OSA treatment with a continuous positive airway pressure device (CPAP) on the LA volume and function, as well as on the LV diastolic function.
In total, 56 OSA patients were studied. All patients underwent real-time three-dimensional (RT3DE) and two-dimensional echocardiogram with tissue Doppler evaluation in order to estimate LA volumes, function and LV diastolic performance. A total of 30 patients with an apnoea-hypopnoea index greater than 20 were randomly selected to receive sham CPAP (n = 15) or effective CPAP (n = 15) for 24 weeks. They underwent echo examination on three different occasions: at baseline, after 12 weeks and 24 weeks of CPAP or sham CPAP.
In the effective CPAP group we observed the following changes from the baseline to the 24-week echo evaluation: (a) a reduction in the E/E' ratio (10.3 (1.9) to 7.9 (1.3), p = 0.03); (b) an increase in the LA passive emptying fraction (28.8% (11.9%) to 46.8% (9.3%), p = 0.01); and (c) a reduction in the LA active emptying fraction (42.7% (11.5%) to 25.7 (15.7), p<0.01). In the sham group, there were no changes from the baseline to the 24-week echo. We found a positive correlation between 24 week/baseline LA active emptying volume and 24 week/baseline E/E' ratios (r = 0.40, p<0.05) and a negative correlation between 24 week/baseline LA passive emptying volume and 24 week/baseline E/E' ratios (r = -0.53, p<0.05). No significant changes were found on LA total emptying fraction.
CPAP improved LV diastolic function and LA passive emptying, but not LA structural variables in OSA patients.
NCT00768807.
阻塞性睡眠呼吸暂停（OSA）已被报道为左心室（LV）舒张功能障碍和左心房（LA）重塑的预测指标。本研究的目的是评估使用持续气道正压通气设备（CPAP）治疗OSA对左心房容积和功能以及左心室舒张功能的影响。
共研究了56例OSA患者。所有患者均接受实时三维（RT3DE）和二维超声心动图检查，并进行组织多普勒评估，以估计左心房容积、功能和左心室舒张功能。共有30例呼吸暂停低通气指数大于20的患者被随机选择接受假CPAP（n = 15）或有效CPAP（n = 15）治疗24周。他们在三个不同时间点接受超声心动图检查：基线时、CPAP或假CPAP治疗12周后和24周后。
在有效CPAP组中，从基线到24周超声心动图评估观察到以下变化：（a）E/E'比值降低（从10.3（1.9）降至7.9（1.3），p = 0.03）；（b）左心房被动排空分数增加（从28.8%（11.9%）增至46.8%（9.3%），p = 0.01）；（c）左心房主动排空分数降低（从42.7%（11.5%）降至25.7（15.7），p<0.01）。在假治疗组中，从基线到24周超声心动图检查无变化。我们发现24周/基线左心房主动排空容积与24周/基线E/E'比值之间呈正相关（r = 0.40，p<0.05），24周/基线左心房被动排空容积与24周/基线E/E'比值之间呈负相关（r = -0.53，p<0.05）。左心房总排空分数未发现显著变化。
CPAP改善了OSA患者的左心室舒张功能和左心房被动排空，但未改善左心房结构变量。
NCT00768807。
