Effect of positive airway pressure on diastolic function in coronary artery disease patients with non-sleepy obstructive sleep apnea

Yüksel Peker, Helena Glantz, Erik Östgärd Thunström, Cecilia Wallentin Guron, Harun Uzel, Mustafa Saygın, Johan D. Herlitz, Magnus Carl Johansson

2016

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DOI 10.1183/13993003.congress-2016.oa1806
Data confidence 70 medium
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Abstract

Background: We recently demonstrated that obstructive sleep apnea (OSA) was associated with worse diastolic function in patients with coronary artery disease (CAD). In the current randomized controlled study, we addressed if continuous positive airway pressure (CPAP) treatment would improve diastolic function in CAD patients with nonsleepy OSA. Methods: Between December 2005 and November 2010, 244 revascularized CAD patients with nonsleepy OSA (apnea-hypopnea index (AHI)≥15 h-1, and Epworth Sleepiness Scale [ESS] score <10) were randomly assigned to CPAP or no-CPAP. Echocardiographic measurements were obtained at baseline, after 3 and 12 months, respectively. Results: In all, 171 patients (87 assigned to CPAP; 84 to no-CPAP) with preserved left ventricular ejection fraction ≥50%, and with no atrial fibrillation or severe valve abnormalities, and with technically adequate echocardiograms at baseline and at the follow-ups, were included. CPAP had no significant impact on echocardiographic parameters of the diastolic dysfunction (enlarged left atrium, decreased mean é tissue velocity, or increased E/é filling index) in the intention-to-treat population. On-treatment analysis revealed a significant increase in diastolic relaxation velocity in patients using CPAP for ≥4 h/night (odds ratio 2.3, 95% confidence interval 1.0-4.9; p=0.039) after adjustment for age, sex, body-mass-index, and left atrium diameter at baseline. Conclusion: CPAP prescription did not improve diastolic dysfunction in CAD patients with nonsleepy OSA. However, a significant increase in diastolic relaxation velocity was observed after one year in those compliant with the treatment.