European Heart Journal Advance Access originally published online on April 30, 2007
European Heart Journal 2007 28(10):1221-1227; doi:10.1093/eurheartj/ehm131
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Auto-titrating continuous positive airway pressure therapy in patients with chronic heart failure and obstructive sleep apnoea: a randomized placebo-controlled trial
1 Cardiovascular Research, Centre for Cardiovascular Science, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh EH16 4SB, UK
2 Department of Sleep Medicine, University of Edinburgh, UK
3 Western Infirmary, Glasgow, UK
4 Royal Brompton Hospital, London, UK
Received 13 December 2006; revised 22 March 2007; accepted 29 March 2007; online publish-ahead-of-print 30 April 2007.
* Corresponding author. Tel: +44 131 242 6422; fax: +44 131 242 6422. E-mail address: lindsay.smith{at}ed.ac.uk
See page 1184 for the editorial comment on this article (doi:10.1093/eurheartj/ehm086)
Aims: Obstructive sleep apnoea (OSA) is highly prevalent in patients with chronic heart failure (CHF) and may contribute to CHF progression. We aimed to determine whether treatment of OSA with continuous positive airway pressure (CPAP) would improve subjective and objective measures of heart failure severity in patients with CHF and OSA.
Methods and results: Twenty-six patients with stable symptomatic CHF and OSA were randomized to nocturnal auto-titrating CPAP or sham CPAP for 6 weeks each in crossover design. Study co-primary endpoints were changes in peak VO2 and 6 min walk distance. Secondary endpoints were changes in left ventricular ejection fraction, VE/VCO2 slope, plasma neurohormonal markers, and quality-of-life measures. Twenty-three patients completed the study protocol. Mean CPAP and sham CPAP usage were 3.5 ± 2.5 and 3.3 ± 2.2 h/night, respectively (P = 0.31). CPAP treatment was associated with improvements in daytime sleepiness (Epworth Sleepiness Score 7 ± 4 vs. 8 ± 5, P = 0.04) but not in other quality-of-life measures. There were no changes in other study endpoints.
Conclusion: In patients with CHF and OSA, auto-titrating CPAP improves daytime sleepiness but not other subjective or objective measures of CHF severity. These data suggest that the potential therapeutic benefits of CPAP in CHF are achieved by alleviation of OSA rather than by improvement in cardiac function.
Key Words: Congestive heart failure • Obstructive sleep apnoea • Continuous positive airway pressure
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