Craig Sonya, Kylintireas Ilias, Kohler Malcolm, Nicoll Debby, Bratton Daniel J, Nunn Andrew J, Leeson Paul, Neubauer Stefan, Stradling John R
Oxford Centre for Respiratory Medicine, Oxford Biomedical Research Centre and Oxford University, Oxford, UK.
Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK.
J Clin Sleep Med. 2015 Sep 15;11(9):967-73. doi: 10.5664/jcsm.5004.
Minimally symptomatic obstructive sleep apnea (OSA) is highly prevalent, and the effects of continuous positive airway pressure (CPAP) on myocardial function in these patients are unknown. The MOSAIC randomized, controlled trial of CPAP for minimally symptomatic OSA assessed the effect of CPAP on myocardial function in a subset of patients.
Two centers taking part in the MOSAIC trial randomized 238 patients in parallel to 6 months of CPAP (120) or standard care (118). Of these, 168 patients had echocardiograms, and 68 patients had a cardiac magnetic resonance scan (CMR). A larger group (314) from 4 centers had brain natriuretic peptide (BNP) measured.
Mean (SD) baseline oxygen desaturation index (ODI) and Epworth sleepiness score (ESS) were 13.5 (13.2), and 8.4 (4.0), respectively. CPAP significantly reduced ESS and ODI. Baseline LV ejection fraction (LVEF) was well preserved (60.4%). CPAP had no significant effect on echo-derived left atrial (LA) area (-1.0 cm2, 95% CI -2.6 to +0.6, p = 0.23) or early to late left ventricular filling velocity (E/A) ratio (-0.01, 95% CI -0.07 to +0.05, p = 0.79). There was a small change in echo-derived LV end diastolic volume (EDV) with CPAP (-5.9 mL, 95% CI -10.6 to -1.2, p = 0.015). No significant changes were detected by CMR on LV mass index (+1.1 g/m(2), 95% CI -5.9 to +8.0, p = 0.76) or LVEF (+0.8%, 95% CI -1.2 to +2.8, p = 0.41). CPAP did not affect BNP levels (p = 0.16).
Six months of CPAP therapy does not change cardiac functional or structural parameters measured by echocardiogram or CMR in patients with minimally symptomatic mild-to-moderate OSA.
ISRCTN 34164388 (http://isrctn.org).
症状轻微的阻塞性睡眠呼吸暂停（OSA）极为普遍，持续气道正压通气（CPAP）对这些患者心肌功能的影响尚不清楚。CPAP治疗症状轻微的OSA的MOSAIC随机对照试验评估了CPAP对部分患者心肌功能的影响。
参与MOSAIC试验的两个中心将238例患者平行随机分为两组，分别接受6个月的CPAP治疗（120例）或标准治疗（118例）。其中，168例患者进行了超声心动图检查，68例患者进行了心脏磁共振扫描（CMR）。来自4个中心的更大一组（314例）患者检测了脑钠肽（BNP）。
平均（标准差）基线氧饱和度下降指数（ODI）和爱泼沃斯嗜睡量表（ESS）评分分别为13.5（13.2）和8.4（4.0）。CPAP显著降低了ESS和ODI。基线左心室射血分数（LVEF）保持良好（60.4%）。CPAP对超声心动图测得的左心房（LA）面积（-1.0 cm²，95%可信区间-2.6至+0.6，p = 0.23）或左心室早期与晚期充盈速度（E/A）比值（-0.01，95%可信区间-0.07至+0.05，p = 0.79）无显著影响。CPAP使超声心动图测得的左心室舒张末期容积（EDV）有小幅变化（-5.9 mL，95%可信区间-10.6至-1.2，p = 0.015）。CMR未检测到左心室质量指数（+1.1 g/m²，95%可信区间-5.9至+8.0，p = 0.76）或LVEF（+0.8%，95%可信区间-1.2至+2.8，p = 0.41）有显著变化。CPAP对BNP水平无影响（p = 0.16）。
对于症状轻微的轻至中度OSA患者，6个月的CPAP治疗不会改变通过超声心动图或CMR测量的心脏功能或结构参数。
ISRCTN 34164388（http://isrctn.org）
