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Cardiac Effects of Continuous and Bi-level Positive Airway Pressure for Patients with Heart Failure and Obstructive Sleep Apnea: A Pilot Study

¹From the Sleep-Heart Program, The Ohio Sate University, Columbus, Ohio ²Division of Pulmonary, Critical Care, and Sleep Medicine, The Ohio Sate University, Columbus, Ohio ³Center for Biostatistics and College of Public Health and College of Public Health,The Ohio Sate University, Columbus, Ohio ⁴Division of Cardiovascular Medicine, The Ohio Sate University, Columbus, Ohio

Rami.Khayat{at}osumc.edu

Abstract

BackgroundObstructive Sleep Apnea (OSA) is prevalent in patients with heart failure. Treatment with Continuous Positive Airway Pressure (CPAP) improves systolic function in patients with heart failure. Bi-level Positive Airway Pressure (Bilevel PAP) is another treatment modality for OSA. The intermediate term effect of bilevel PAP on left ventricular ejection fraction in patients with stable heart failure and OSA has not been compared to the effect of CPAP.

MethodsIn this pilot randomized controlled trial, patients with stable systolic dysfunction and newly diagnosed OSA (n=24) were randomized to receive either CPAP or bilevel PAP. Titration was done in the Sleep laboratory using CPAP based algorithm. Primary outcome was the improvement in left ventricular ejection fraction (LVEF) after 3 months of treatment. Other measurements included: 6 minute walk test, Epworth Sleepiness Scale and Living with heart failure Minnesota Questionnaire.

ResultsBilevel PAP increased LVEF 7.9 (LVEF percent scale) more than CPAP ((95% CI, 2.3, 13.4, P= 0.01). In the bilevel PAP group, LVEF increased 8.5% (95% CI 3.7, 13.4 P 0.002). In the CPAP group, LVEF did not change significantly (0.5% (95% CI -2.7, 3.7 p 0.7). The difference in LVEF improvement between the two groups was still significant after adjustment for adherence, level of treatment positive pressure, body mass index, and severity of OSA.

ConclusionThis pilot randomized controlled trial suggests that bilevel PAP is superior to CPAP in improving LVEF in patients with systolic dysfunction and OSA. Larger trials are required to evaluate the mechanism behind this effect.