| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
(Circulation. 1998;98:2269-2275.)
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports |
Effects of Continuous Positive Airway Pressure on Obstructive Sleep Apnea and Left Ventricular Afterload in Patients With Heart Failure
From the Sleep Research Laboratories of the Rehabilitation Institute of Toronto and Mount Sinai Hospital and the Department of Medicine of the University of Toronto, Toronto, Ontario, Canada.
Background—The objectives of this study were to determine the effects of continuous positive airway pressure (CPAP) on blood pressure (BP) and systolic left ventricular transmural pressure (LVPtm) during sleep in congestive heart failure (CHF) patients with obstructive sleep apnea (OSA). In CHF patients with OSA, chronic nightly CPAP treatment abolishes OSA and improves left ventricular (LV) ejection fraction. We hypothesized that one mechanism whereby CPAP improves cardiac function in CHF patients with OSA is by lowering LV afterload during sleep.
Methods and Results—Eight pharmacologically treated CHF patients with OSA were studied during overnight polysomnography. BP and esophageal pressure (Pes) (ie, intrathoracic pressure) were recorded before the onset of sleep and during stage 2 non–rapid eye movement sleep before, during, and after CPAP application. OSA was associated with an increase in systolic BP (from 120.4±7.8 to 131.8±10.6 mm Hg, P<0.05) and systolic LVPtm (from 124.4±7.7 to 137.2±10.8 mm Hg, P<0.05) from wakefulness to stage 2 sleep. CPAP alleviated OSA, improved oxyhemoglobin saturation, and reduced systolic BP in stage 2 sleep to 115.4±8.5 mm Hg (P<0.01), systolic LVPtm to 117.4±8.5 mm Hg (P<0.01), heart rate, Pes amplitude, and respiratory rate.
Conclusions—In CHF patients with OSA, LV afterload increases from wakefulness to stage 2 sleep. By alleviating OSA, CPAP reduces LV afterload and heart rate, unloads inspiratory muscles, and improves arterial oxygenation during stage 2 sleep. CPAP is a nonpharmacological means of further reducing afterload and heart rate during sleep in pharmacologically treated CHF patients with OSA.
Key Words: blood pressure • lung • heart-assist device • respiration • physiology
This article has been cited by other articles:
 |
|
 |
|
  S. J. Asirvatham and S. Kapa Sleep Apnea and Atrial Fibrillation The Autonomic Link. J. Am. Coll. Cardiol., November 24, 2009; 54(22): 2084 - 2086. [Full Text] [PDF]
|
|
|
|
 |
|
 W Oliveira, O Campos, F Cintra, L Matos, M L C Vieira, B Rollim, L Fujita, S Tufik, and D Poyares Impact of continuous positive airway pressure treatment on left atrial volume and function in patients with obstructive sleep apnoea assessed by real-time three-dimensional echocardiography Heart, November 15, 2009; 95(22): 1872 - 1878. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. A Chami, M. J Keyes, J. A Vita, G. F Mitchell, M. G Larson, S. Fan, R. S Vasan, G. T O'Connor, E. J Benjamin, and D. J Gottlieb Brachial artery diameter, blood flow and flow-mediated dilation in sleep-disordered breathing Vascular Medicine, November 1, 2009; 14(4): 351 - 360. [Abstract] [PDF]
|
|
|
|
 |
|
 R. N. Khayat, W. T. Abraham, B. Patt, M. Pu, and D. Jarjoura In-Hospital Treatment of Obstructive Sleep Apnea During Decompensation of Heart Failure Chest, October 1, 2009; 136(4): 991 - 997. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J S Floras Should sleep apnoea be a specific target of therapy in chronic heart failure? Heart, July 1, 2009; 95(13): 1041 - 1046. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. A. Hunt, W. T. Abraham, M. H. Chin, A. M. Feldman, G. S. Francis, T. G. Ganiats, M. Jessup, M. A. Konstam, D. M. Mancini, K. Michl, et al. 2009 Focused Update Incorporated Into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Developed in Collaboration With the International Society for Heart and Lung Transplantation J. Am. Coll. Cardiol., April 14, 2009; 53(15): e1 - e90. [Full Text] [PDF]
|
|
|
|
 |
|
 2005 WRITING COMMITTEE MEMBERS, S. A. Hunt, W. T. Abraham, M. H. Chin, A. M. Feldman, G. S. Francis, T. G. Ganiats, M. Jessup, M. A. Konstam, D. M. Mancini, et al. 2009 Focused Update Incorporated Into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: Developed in Collaboration With the International Society for Heart and Lung Transplantation Circulation, April 14, 2009; 119(14): e391 - e479. [Full Text] [PDF]
|
|
|
|
 |
|
 G. Jayaraman, H. Sharafkhaneh, M. Hirshkowitz, and A. Sharafkhaneh Review: Pharmacotherapy of obstructive sleep apnea Therapeutic Advances in Respiratory Disease, December 1, 2008; 2(6): 375 - 386. [Abstract] [PDF]
|
|
|
|
|
|
R. N. Khayat, W. T. Abraham, B. Patt, M. Roy, K. Hua, and D. Jarjoura Cardiac Effects of Continuous and Bilevel Positive Airway Pressure for Patients With Heart Failure and Obstructive Sleep Apnea: A Pilot Study Chest, December 1, 2008; 134(6): 1162 - 1168. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
V. K. Somers, D. P. White, R. Amin, W. T. Abraham, F. Costa, A. Culebras, S. Daniels, J. S. Floras, C. E. Hunt, L. J. Olson, et al. Sleep Apnea and Cardiovascular Disease: An American Heart Association/American College of Cardiology Foundation Scientific Statement From the American Heart Association Council for High Blood Pressure Research Professional Education Committee, Council on Clinical Cardiology, Stroke Council, and Council on Cardiovascular Nursing In Collaboration With the National Heart, Lung, and Blood Institute National Center on Sleep Disorders Research (National Institutes of Health) Circulation, September 2, 2008; 118(10): 1080 - 1111. [Full Text] [PDF]
|
|
|
|
|
|
V. K. Somers, D. P. White, R. Amin, W. T. Abraham, F. Costa, A. Culebras, S. Daniels, J. S. Floras, C. E. Hunt, L. J. Olson, et al. Sleep Apnea and Cardiovascular Disease: An American Heart Association/American College of Cardiology Foundation Scientific Statement From the American Heart Association Council for High Blood Pressure Research Professional Education Committee, Council on Clinical Cardiology, Stroke Council, and Council on Cardiovascular Nursing In Collaboration With the National Heart, Lung, and Blood Institute National Center on Sleep Disorders Research (National Institutes of Health) J. Am. Coll. Cardiol., August 19, 2008; 52(8): 686 - 717. [Full Text] [PDF]
|
|
|
|
|
|
H. A. Chami, R. B. Devereux, J. S. Gottdiener, R. Mehra, M. J. Roman, E. J. Benjamin, and D. J. Gottlieb Left Ventricular Morphology and Systolic Function in Sleep-Disordered Breathing: The Sleep Heart Health Study Circulation, May 20, 2008; 117(20): 2599 - 2607. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. Yumino and T. D. Bradley Central Sleep Apnea and Cheyne-Stokes Respiration Proceedings of the ATS, February 15, 2008; 5(2): 226 - 236. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J Amit Benjamin and K E Lewis Sleep-disordered breathing and cardiovascular disease Postgrad. Med. J., January 1, 2008; 84(987): 15 - 22. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. A. Bazzano, Z. Khan, K. Reynolds, and J. He Effect of Nocturnal Nasal Continuous Positive Airway Pressure on Blood Pressure in Obstructive Sleep Apnea Hypertension, August 1, 2007; 50(2): 417 - 423. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. S. Floras and T. D. Bradley Treating Obstructive Sleep Apnea: Is There More to the Story Than 2 Millimeters of Mercury? Hypertension, August 1, 2007; 50(2): 289 - 291. [Full Text] [PDF]
|
|
|
|
 |
|
 L. A. Smith, M. Vennelle, R. S. Gardner, T. A. McDonagh, M. A. Denvir, N. J. Douglas, and D. E. Newby Auto-titrating continuous positive airway pressure therapy in patients with chronic heart failure and obstructive sleep apnoea: a randomized placebo-controlled trial Eur. Heart J., May 2, 2007; 28(10): 1221 - 1227. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Wang, J. D. Parker, G. E. Newton, J. S. Floras, S. Mak, K.-L. Chiu, P. Ruttanaumpawan, G. Tomlinson, and T. D. Bradley Influence of Obstructive Sleep Apnea on Mortality in Patients With Heart Failure J. Am. Coll. Cardiol., April 17, 2007; 49(15): 1625 - 1631. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Shibata, R. Zhang, J. Hastings, Q. Fu, K. Okazaki, K.-i. Iwasaki, and B. D. Levine Cascade model of ventricular-arterial coupling and arterial-cardiac baroreflex function for cardiovascular variability in humans Am J Physiol Heart Circ Physiol, November 1, 2006; 291(5): H2142 - H2151. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Nakashima, T. Katayama, C. Takagi, K. Amenomori, M. Ishizaki, Y. Honda, and S. Suzuki Obstructive sleep apnoea inhibits the recovery of left ventricular function in patients with acute myocardial infarction Eur. Heart J., October 1, 2006; 27(19): 2317 - 2322. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Arzt and T. D. Bradley Treatment of Sleep Apnea in Heart Failure Am. J. Respir. Crit. Care Med., June 15, 2006; 173(12): 1300 - 1308. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Usui, J. D. Parker, G. E. Newton, J. S. Floras, C. M. Ryan, and T. D. Bradley Left Ventricular Structural Adaptations to Obstructive Sleep Apnea in Dilated Cardiomyopathy Am. J. Respir. Crit. Care Med., May 15, 2006; 173(10): 1170 - 1175. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Ferreira, J. Winck, P. Bettencourt, and F. Rocha-Goncalves Heart failure and sleep apnoea: To sleep perchance to dream Eur J Heart Fail, May 1, 2006; 8(3): 227 - 236. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. R. Bonsignore, G. Parati, G. Insalaco, P. Castiglioni, O. Marrone, S. Romano, A. Salvaggio, G. Mancia, G. Bonsignore, and M. Di Rienzo Baroreflex control of heart rate during sleep in severe obstructive sleep apnoea: effects of acute CPAP Eur. Respir. J., January 1, 2006; 27(1): 128 - 135. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Arzt, T. Young, L. Finn, J. B. Skatrud, and T. D. Bradley Association of Sleep-disordered Breathing and the Occurrence of Stroke Am. J. Respir. Crit. Care Med., December 1, 2005; 172(11): 1447 - 1451. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L J Cormican and A Williams Sleep disordered breathing and its treatment in congestive heart failure Heart, October 1, 2005; 91(10): 1265 - 1270. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C M Ryan, K Usui, J S Floras, and T D Bradley Effect of continuous positive airway pressure on ventricular ectopy in heart failure patients with obstructive sleep apnoea Thorax, September 1, 2005; 60(9): 781 - 785. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. A. Arias, F. Garcia-Rio, A. Alonso-Fernandez, O. Mediano, I. Martinez, and J. Villamor Obstructive Sleep Apnea Syndrome Affects Left Ventricular Diastolic Function: Effects of Nasal Continuous Positive Airway Pressure in Men Circulation, July 19, 2005; 112(3): 375 - 383. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Usui, T. D. Bradley, J. Spaak, C. M. Ryan, T. Kubo, Y. Kaneko, and J. S. Floras Inhibition of Awake Sympathetic Nerve Activity of Heart Failure Patients With Obstructive Sleep Apnea by Nocturnal Continuous Positive Airway Pressure J. Am. Coll. Cardiol., June 21, 2005; 45(12): 2008 - 2011. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. M. Ryan and T. D. Bradley Periodicity of Obstructive Sleep Apnea in Patients With and Without Heart Failure Chest, February 1, 2005; 127(2): 536 - 542. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. K. Gehlbach and E. Geppert The Pulmonary Manifestations of Left Heart Failure Chest, February 1, 2004; 125(2): 669 - 682. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Ancoli-Israel, E. R. DuHamel, C. Stepnowsky, R. Engler, M. Cohen-Zion, and M. Marler The Relationship Between Congestive Heart Failure, Sleep Apnea, and Mortality in Older Men Chest, October 1, 2003; 124(4): 1400 - 1405. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Kanagala, N. S. Murali, P. A. Friedman, N. M. Ammash, B. J. Gersh, K. V. Ballman, A. S. M. Shamsuzzaman, and V. K. Somers Obstructive Sleep Apnea and the Recurrence of Atrial Fibrillation Circulation, May 27, 2003; 107(20): 2589 - 2594. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. o-D. L. Lattimore, D. S. Celermajer, and I. Wilcox Obstructive sleep apnea and cardiovascular disease J. Am. Coll. Cardiol., May 7, 2003; 41(9): 1429 - 1437. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. O. Ventura, S. Potluri, and M. R. Mehra The Conundrum of Sleep Breathing Disorders in Heart Failure Chest, May 1, 2003; 123(5): 1332 - 1334. [Full Text] [PDF]
|
|
|
|
|
|
D. D. Sin, F. Fitzgerald, J. D. Parker, G. E. Newton, A. G. Logan, J. S. Floras, and T. D. Bradley Relationship of Systolic BP to Obstructive Sleep Apnea in Patients With Heart Failure Chest, May 1, 2003; 123(5): 1536 - 1543. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. D. Bradley and J. S. Floras Sleep Apnea and Heart Failure: Part I: Obstructive Sleep Apnea Circulation, April 1, 2003; 107(12): 1671 - 1678. [Full Text] [PDF]
|
|
|
|
 |
|
 Y. Kaneko, J. S. Floras, K. Usui, J. Plante, R. Tkacova, T. Kubo, S.-i. Ando, and T. D. Bradley Cardiovascular Effects of Continuous Positive Airway Pressure in Patients with Heart Failure and Obstructive Sleep Apnea N. Engl. J. Med., March 27, 2003; 348(13): 1233 - 1241. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
O. Marrone, A. Salvaggio, M.R. Bonsignore, G. Insalaco, and G. Bonsignore Blood pressure responsiveness to obstructive events during sleep after chronic CPAP Eur. Respir. J., March 1, 2003; 21(3): 509 - 514. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A.G. Logan, R. Tkacova, S.M. Perlikowski, R.S. Leung, A. Tisler, J.S. Floras, and T.D. Bradley Refractory hypertension and sleep apnoea: effect of CPAP on blood pressure and baroreflex Eur. Respir. J., February 1, 2003; 21(2): 241 - 247. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J.-P. Laaban, S. Pascal-Sebaoun, E. Bloch, E. Orvoen-Frija, J.-M. Oppert, and G. Huchon Left Ventricular Systolic Dysfunction in Patients With Obstructive Sleep Apnea Syndrome Chest, October 1, 2002; 122(4): 1133 - 1138. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Nohria, E. Lewis, and L. W. Stevenson Medical Management of Advanced Heart Failure JAMA, February 6, 2002; 287(5): 628 - 640. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
V. Belozeroff, R. B. Berry, C. S. H. Sassoon, and M. C. K. Khoo Effects of CPAP therapy on cardiovascular variability in obstructive sleep apnea: a closed-loop analysis Am J Physiol Heart Circ Physiol, January 1, 2002; 282(1): H110 - H121. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. S. T. LEUNG and T. DOUGLAS BRADLEY Sleep Apnea and Cardiovascular Disease Am. J. Respir. Crit. Care Med., December 15, 2001; 164(12): 2147 - 2165. [Full Text] [PDF]
|
|
|
|
|
|
A. T. Yan, T. D. Bradley, and P. P. Liu The Role of Continuous Positive Airway Pressure in the Treatment of Congestive Heart Failure Chest, November 1, 2001; 120(5): 1675 - 1685. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Tkacova, M. Niroumand, G. Lorenzi-Filho, and T. D. Bradley Overnight Shift From Obstructive to Central Apneas in Patients With Heart Failure : Role of PCO2 and Circulatory Delay Circulation, January 16, 2001; 103(2): 238 - 243. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Kato, P. Roberts-Thomson, B. G. Phillips, W. G. Haynes, M. Winnicki, V. Accurso, and V. K. Somers Impairment of Endothelium-Dependent Vasodilation of Resistance Vessels in Patients With Obstructive Sleep Apnea Circulation, November 21, 2000; 102(21): 2607 - 2610. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. Chen, Q. Shi, and S. M. Scharf Hemodynamic effects of periodic obstructive apneas in sedated pigs with congestive heart failure J Appl Physiol, March 1, 2000; 88(3): 1051 - 1060. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Javaheri Effects of Continuous Positive Airway Pressure on Sleep Apnea and Ventricular Irritability in Patients With Heart Failure Circulation, February 1, 2000; 101(4): 392 - 397. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. MEHTA, P. P. LIU, F. S. FITZGERALD, Y. K. ALLIDINA, and T. DOUGLAS BRADLEY Effects of Continuous Positive Airway Pressure on Cardiac Volumes in Patients with Ischemic and Dilated Cardiomyopathy Am. J. Respir. Crit. Care Med., January 1, 2000; 161(1): 128 - 134. [Abstract] [Full Text]
|
|
|
|
|
|
K. Narkiewicz, M. Kato, B. G. Phillips, C. A. Pesek, D. E. Davison, and V. K. Somers Nocturnal Continuous Positive Airway Pressure Decreases Daytime Sympathetic Traffic in Obstructive Sleep Apnea Circulation, December 7, 1999; 100(23): 2332 - 2335. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Chin, K. Shimizu, T. Nakamura, N. Narai, H. Masuzaki, Y. Ogawa, M. Mishima, T. Nakamura, K. Nakao, and M. Ohi Changes in Intra-Abdominal Visceral Fat and Serum Leptin Levels in Patients With Obstructive Sleep Apnea Syndrome Following Nasal Continuous Positive Airway Pressure Therapy Circulation, August 17, 1999; 100(7): 706 - 712. [Abstract] [Full Text] [PDF]
|
|