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(Circulation. 2000;102:61.)
© 2000 American Heart Association, Inc.
Clinical Investigation and Reports |
Effects of Continuous Positive Airway Pressure on Cardiovascular Outcomes in Heart Failure Patients With and Without Cheyne-Stokes Respiration
From the Sleep Research Laboratory of the Toronto Rehabilitation Institute (D.D.S., F.S.F., T.D.B.) and the Departments of Medicine at the Toronto General Hospital (University Health Network) (D.D.S., F.S.F., P.P.L., T.D.B.) and Mount Sinai Hospital (A.G.L.), University of Toronto, Toronto, Ontario, Canada.
Correspondence to T. Douglas Bradley, MD, ES 12-421, The Toronto General Hospital/University Health Network, 200 Elizabeth St, Toronto, ON M5G 2C4, Canada. E-mail douglas.bradley{at}utoronto.ca
Background—Continuous positive airway pressure (CPAP) improves cardiac function in patients with congestive heart failure (CHF) who also have Cheyne-Stokes respiration and central sleep apnea (CSR-CSA). However, the effects of CPAP in CHF patients without CSR-CSA have not been tested, and the long-term effects of this treatment on clinical cardiovascular outcomes are unknown.
Methods and Results—We conducted a randomized, controlled trial in which 66 patients with CHF (29 with and 37 without CSR-CSA) were randomized to either a group that received CPAP nightly or to a control group. Change in left ventricular ejection fraction (LVEF) from baseline to 3 months and the combined mortality-cardiac transplantation rate over the median 2.2-year follow-up period were compared between the CPAP-treated and control groups. For the entire group of patients, CPAP had no significant effect on LVEF, but it was associated with a 60% relative risk reduction (95% confidence interval, 2% to 64%) in mortality–cardiac transplantation rate in patients who complied with CPAP therapy. Stratified analysis of patients with and without CSR-CSA revealed that those with CSR-CSA experienced both a significant improvement in LVEF at 3 months and a relative risk reduction of 81% (95% confidence interval, 26% to 95%) in the mortality–cardiac transplantation rate of those who used CPAP. CPAP had no significant effect on either of these outcomes in patients without CSR-CSA.
Conclusions—CPAP improves cardiac function in CHF patients with CSR-CSA but not in those without it. Although not definitive, our findings also suggest that CPAP can reduce the combined mortality–cardiac transplantation rate in those CHF patients with CSR-CSA who comply with therapy.
Key Words: heart assist devices • sleep apnea, central • clinical trials
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