European Heart Journal Advance Access originally published online on February 23, 2006
European Heart Journal 2006 27(9):1106-1113; doi:10.1093/eurheartj/ehi807
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Pulmonary hypertension in obstructive sleep apnoea: effects of continuous positive airway pressure
A randomized, controlled cross-over study
1 Servicios de Cardiología, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, Spain
2 Neumología, Hospital Universitario La Paz, Universidad Autónoma de Madrid, c/Alfredo Marqueríe 11, izqda-1°A, 28034 Madrid, Spain
3 Laboratorio de Bioquímica, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, Spain
Received 23 June 2005; revised 10 January 2006; accepted 3 February 2006; online publish-ahead-of-print 23 February 2006.
* Corresponding author. Tel: +34 91 7300170; fax: +34 91 7277096. E-mail address: fgr01m{at}jazzfree.com
See page 1016 for the editorial comment on this article (doi:10.1093/eurheartj/ehi850)
Aims We tested the hypothesis that: (i) obstructive sleep apnoea (OSA) by itself originates pulmonary hypertension (PH); and (ii) the application of continuous positive airway pressure (CPAP) can reduce pulmonary pressure.
Methods and results In this randomized and cross-over trial, 23 middle-aged OSA (apnoea–hypopnoea index, 44.1±29.3 h–1) and otherwise healthy patients and 10 control subjects were included. OSA patients randomly received either sham or effective CPAP for 12 weeks. Echocardiographic parameters, blood pressure recordings, and urinary catecholamine levels were obtained at baseline and after both treatment modalities. At baseline, OSA patients had higher pulmonary artery systolic pressure than control subjects (29.8±8.8 vs. 23.4±4.1 mmHg, respectively, P=0.036). Ten out of 23 patients [43%, (95% CI: 23–64%)] and none of the control subjects had PH at baseline (P=0.012). Two patients were removed from the study because of inadequate CPAP compliance. Effective CPAP induced a significant reduction in the values for pulmonary systolic pressure (from 28.9±8.6 to 24.0±5.8 mmHg, P<0.0001). The reduction was greatest in patients with either PH or left ventricular diastolic dysfunction at baseline.
Conclusion Severe OSA is independently associated with PH in direct relationship with disease severity and presence of diastolic dysfunction. Application of CPAP reduces pulmonary systolic pressure levels.
Key Words: Obstructive sleep apnoea • Pulmonary hypertension • Continuous positive airway pressure
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