【medical-news】CPAP可改善睡眠呼吸暂停患者的心功能
发布于 2007-01-31 · 浏览 1115 · IP 浙江浙江
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Air pressure therapy improves cardiac efficiency in sleep apnea
30 January 2007
Study findings suggest that continuous positive airway pressure (CPAP) therapy improves cardiac function while preserving cardiac efficiency in patients with obstructive sleep apnea (OSA) and heart failure (HF).
Keiichiro Yoshinaga (Ottawa University, Ontario, Canada) and colleagues report that nightly CPAP therapy in seven patients with systolic HF resulted in improvements in left ventricular ejection fraction (LVEF) at the same time as reduced LV oxidative metabolism and maintained stroke volume index (SVI).
Writing in the Journal of the American College of Cardiology, the researchers explain that sleep-related breathing disorders, including OSA, often co-exist with HF and may contribute to disease progression. CPAP therapy appears to improve LV systolic function in such patients, they say, but it remains unclear how it impacts on cardiac metabolism and efficiency.
The team studied 12 stable patients with New York Heart Association Class 2 or 3 HF, and a LVEF ≤40%. Patients underwent polysomnography and seven were found to have OSA.
The researchers used [11C] acetate positron emission tomography (PET) to measure myocardial oxidative metabolism, and used this in conjunction with echocardiographic measures to calculate the work metabolic index (WMI), an indicator of myocardial efficiency, in each patient.
All patients underwent these studies at baseline, and those with OSA were evaluated again after a short daytime CPAP session, and once more after 6 weeks of nocturnal CPAP therapy. The five patients without OSA who served as controls did not undergo CPAP but were also re-evaluated at 6 weeks.
The short-term CPAP treatment lowered patients' SVI, LVEF, and oxidative metabolism, with no change in WMI, the authors report.
Six weeks of CPAP therapy cured the OSA and patients had significantly increased LVEF, from 38.4% to 43.4% (p=0.031), with a tendency towards reduced oxidative metabolism (0.047 to 0.040/min) and improved WMI (7.13 x 106 to 8.17 x 106 mmHg.ml/m2 (p=0.031).
These effects were seen even though there were no changes in blood pressure or heart rate with CPAP.
Measures in the five patients without OSA did not change significantly between baseline and follow up.
Thus, in contrast to a short period of CPAP exposure, longer-term nocturnal treatment "improved LV systolic function while tending to reduce LV oxidative metabolism, thereby improving cardiac efficiency and demonstrating an energy-sparing effect," the authors write.
In an accompanying editorial, Panithaya Chareonthaitawee and Virend Somers, both from Mayo Clinic in Rochester, New York, noted that the effects of CPAP "may be analogous to the chronic effects of beta blockade in HF, which also improves cardiac function while maintaining favorable myocardial energetics."
The experts commented that the issue of whether a metabolic cost is incurred for cardiac function improvements is "especially important because there are no data addressing whether CPAP therapy of OSA in HF has any effect on mortality."
As LVEF is a predictor of survival, they pointed out, the new data suggest that there is indeed potential for improved outcomes with CPAP in patients with concomitant HF and OSA.
However, noting some important limitations to the current study, the authors concluded: "Although the interesting observations… provide further basis for expecting improved outcomes with CPAP therapy in HF patients with OSA, carefully designed large randomized trials are needed to clarify the true effects of CPAP therapy on survival in patients with HF and OSA."
J Am Coll Cardiol 2007; 49: 450-458
http://www.incirculation.net/NewsItem/Air-pressure-therapy-improves-cardiac-efficiency-i.aspx
30 January 2007
Study findings suggest that continuous positive airway pressure (CPAP) therapy improves cardiac function while preserving cardiac efficiency in patients with obstructive sleep apnea (OSA) and heart failure (HF).
Keiichiro Yoshinaga (Ottawa University, Ontario, Canada) and colleagues report that nightly CPAP therapy in seven patients with systolic HF resulted in improvements in left ventricular ejection fraction (LVEF) at the same time as reduced LV oxidative metabolism and maintained stroke volume index (SVI).
Writing in the Journal of the American College of Cardiology, the researchers explain that sleep-related breathing disorders, including OSA, often co-exist with HF and may contribute to disease progression. CPAP therapy appears to improve LV systolic function in such patients, they say, but it remains unclear how it impacts on cardiac metabolism and efficiency.
The team studied 12 stable patients with New York Heart Association Class 2 or 3 HF, and a LVEF ≤40%. Patients underwent polysomnography and seven were found to have OSA.
The researchers used [11C] acetate positron emission tomography (PET) to measure myocardial oxidative metabolism, and used this in conjunction with echocardiographic measures to calculate the work metabolic index (WMI), an indicator of myocardial efficiency, in each patient.
All patients underwent these studies at baseline, and those with OSA were evaluated again after a short daytime CPAP session, and once more after 6 weeks of nocturnal CPAP therapy. The five patients without OSA who served as controls did not undergo CPAP but were also re-evaluated at 6 weeks.
The short-term CPAP treatment lowered patients' SVI, LVEF, and oxidative metabolism, with no change in WMI, the authors report.
Six weeks of CPAP therapy cured the OSA and patients had significantly increased LVEF, from 38.4% to 43.4% (p=0.031), with a tendency towards reduced oxidative metabolism (0.047 to 0.040/min) and improved WMI (7.13 x 106 to 8.17 x 106 mmHg.ml/m2 (p=0.031).
These effects were seen even though there were no changes in blood pressure or heart rate with CPAP.
Measures in the five patients without OSA did not change significantly between baseline and follow up.
Thus, in contrast to a short period of CPAP exposure, longer-term nocturnal treatment "improved LV systolic function while tending to reduce LV oxidative metabolism, thereby improving cardiac efficiency and demonstrating an energy-sparing effect," the authors write.
In an accompanying editorial, Panithaya Chareonthaitawee and Virend Somers, both from Mayo Clinic in Rochester, New York, noted that the effects of CPAP "may be analogous to the chronic effects of beta blockade in HF, which also improves cardiac function while maintaining favorable myocardial energetics."
The experts commented that the issue of whether a metabolic cost is incurred for cardiac function improvements is "especially important because there are no data addressing whether CPAP therapy of OSA in HF has any effect on mortality."
As LVEF is a predictor of survival, they pointed out, the new data suggest that there is indeed potential for improved outcomes with CPAP in patients with concomitant HF and OSA.
However, noting some important limitations to the current study, the authors concluded: "Although the interesting observations… provide further basis for expecting improved outcomes with CPAP therapy in HF patients with OSA, carefully designed large randomized trials are needed to clarify the true effects of CPAP therapy on survival in patients with HF and OSA."
J Am Coll Cardiol 2007; 49: 450-458
http://www.incirculation.net/NewsItem/Air-pressure-therapy-improves-cardiac-efficiency-i.aspx
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