Continuous positive airway pressure therapy reduces right ventricular volume in patients with obstructive sleep apnea: a cardiovascular magnetic resonance study.

Dec 9, 2009Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine

Continuous positive airway pressure therapy lowers right heart size in people with obstructive sleep apnea

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Abstract

CPAP treatment may decrease right ventricular (RV) end-systolic and RV end-diastolic volumes in patients with severe obstructive sleep apnea.

Significant reductions in the Epworth Sleepiness Scale score were observed after 3 months of CPAP therapy (p < 0.0001).
A trend toward improvement in RV ejection fraction was noted, but it did not achieve statistical significance.
Other cardiac measures, including left ventricular volumes and ejection fraction, did not show significant changes.
This study highlights the potential of cardiac magnetic resonance imaging to assess the impact of CPAP on heart structure and function.

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STUDY OBJECTIVES: There are few data on the effects of continuous positive airway pressure (CPAP) therapy on the structural and functional characteristics of the right heart in patients with obstructive sleep apnea (OSA). We sought to leverage the advantages of cardiac magnetic resonance imaging (CMR) and hypothesized that CPAP treatment would improve right ventricular (RV) function in a group of patients with OSA who were free of other comorbid conditions.

METHODS: Patients with severe (apnea-hypopnea index > or = 30/h) untreated OSAwere prospectively enrolled. CMR included 3-dimensional measurement of biventricular size and function, and rest/stress myocardial perfusion and was performed at baseline and after 3 months of CPAP therapy.

RESULTS: Fifteen patients with mild to moderate desaturation were enrolled; 2 could not undergo CMR due to claustrophobia and obesity. There were significant decreases in the Epworth Sleepiness Scale score (p < 0.0001) and RV end-systolic and RV end-diastolic volumes (p < 0.05) with CPAP. There was a trend toward improvement in RV ejection fraction, but the improvement did not reach statistical significance. Other measures such as left ventricular volumes, left ventricular ejection fraction, myocardial perfusion reserve index, and thickness of the interventricular septum and ventricular free wall did not change significantly.

CONCLUSIONS: This preliminary study found that CPAP treatment decreases RV volumes in patients with severe OSA who are otherwise healthy. CMR offers a novel technique to determine the effects of CPAP on ventricular structure and function in patients with OSA. A randomized controlled study is needed to confirm the results of our study.

Continuous positive airway pressure therapy reduces right ventricular volume in patients with obstructive sleep apnea: a cardiovascular magnetic resonance study.

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