Noninvasive positive pressure ventilation therapy can improve cardiac structure and function in patients with coronary artery disease combined with severe obstructive sleep apnea/hypopnea syndrome.

Abstract

To investigate the effects of a noninvasive positive pressure ventilation therapy on cardiac structure and function in patients with coronary heart disease combined with obstructive sleep apnea/hypopnea syndrome (OSAHS). 80 coronary heart disease OSAHS patients from three hospitals in Shanghai were randomly divided into treatment (n=40) and control (n=40) groups. Both groups received standard medications. The treatment group received an additional noninvasive mechanical ventilation support for at least 3 hours (3-6 hours) every night. On the first day after selection and 3 months afterwards participants were examined with echocardiograms, a 24-hour ambulatory blood pressure monitoring and blood analyses. Primary endpoints were left ventricular end diastolic diameter (LVEDd), left ventricular end systolic diameter (LVESd) and left ventricular ejection fraction (LVEF) as well as serum concentrations of N-terminal prohormone of brain natriuretic peptide (NT-ProBNP) and high sensitive C-reactive protein (hsCRP). Secondary endpoints included cardiac death, nonfatal myocardial infarction and hospitalization. After the 3 months study period, patients in the treatment group showed significant better improvements of LVEDd (p=0.02), LVESd (0.035) and LVEF (0.05) and their serum NT-ProBNP (p=0.01) and hsCRP (p=0.04) concentrations were significantly better improved than in the control group. During the 3 months, 3 cardiovascular complications occurred in the treatment group and 9 in the control group (p<0.05). For patients with coronary heart disease combined with obstructive sleep apnea/hypopnea syndrome, noninvasive mechanical ventilation therapy can significantly reduce left ventricular end systolic and end diastolic diameters, improve heart function and reduce the occurrence of cardiovascular complications.