Short-Term CPAP Improves Biventricular Function in Patients with Moderate-Severe OSA and Cardiometabolic Comorbidities.

Ioana Mădălina Zota,Larisa Anghel,Florin Mitu,Daniela Boișteanu,Mihai Roca,Cristian Stătescu,Ovidiu Mitu,Grigore Tinică,Radu Andy Sascău,Maria Magdalena Leon Constantin

doi:10.3390/diagnostics11050889

Abstract

Obstructive sleep apnea (OSA) is the most common form of sleep-disordered breathing, exhibiting an increasing prevalence and several cardiovascular complications. Continuous positive airway pressure (CPAP) is the gold-standard treatment for moderate-severe OSA, but it is associated with poor patient adherence. We performed a prospective study that included 57 patients with newly diagnosed moderate-severe OSA, prior to CPAP initiation. The objective of our study was to assess the impact of short-term CPAP on ventricular function in patients with moderate-severe OSA and cardiometabolic comorbidities. The patients underwent a clinical exam, ambulatory blood pressure monitoring and comprehensive echocardiographic assessment at baseline and after 8 weeks of CPAP. Hypertension, obesity and diabetes were highly prevalent among patients with moderate-severe OSA. Baseline echocardiographic parameters did not significantly differ between patients with moderate and severe OSA. Short-term CPAP improved left ventricular global longitudinal strain (LV-GLS), isovolumetric relaxation time, transmitral E wave amplitude, transmitral E/A ratio, right ventricular (RV) diameter, RV wall thickness, RV systolic excursion velocity (RV S‘) and tricuspid annular plane systolic excursion (TAPSE). Short-term CPAP improves biventricular function, especially the LV-GLS, which is a more sensitive marker of CPAP-induced changes in LV systolic function, compared to LVEF. All these benefits are dependent on CPAP adherence.

Highlights

Obstructive sleep apnea (OSA) is the most common form of sleep-disordered breathing, characterized by repetitive upper airway collapse, despite normal ventilatory efforts [1,2]
The purpose of this study was to determine whether short-term Continuous positive airway pressure (CPAP) is able to improve ventricular function in patients with moderate-severe OSA and cardiometabolic comorbidities
LVEF and MAPSE did not improve after CPAP, the augmentation of left ventricular (LV) systolic function is supported by left ventricular global longitudinal strain (LV-GLS) improvement

Summary

Introduction

Obstructive sleep apnea (OSA) is the most common form of sleep-disordered breathing, characterized by repetitive upper airway collapse, despite normal ventilatory efforts [1,2]. Primarily a sleep-related disorder, OSA promotes a cascade of neurohormonal changes lead by the activation of the renin-angiotensin aldosterone system, autonomic nervous function imbalance, oxidative stress and inflammation [1,2,3,4], and associated with increased cardiovascular risk [1,5,6]. Repetitive hypoxia increases afterload, promoting left ventricular (LV) diastolic dysfunction, which, in time, leads to subsequent impairment of the LV systolic function, especially in the presence of a chronic imbalance between myocardial oxygen demand and supply [7,8,9,10]. Modern imaging techniques such as tissue doppler and speckle tracking echocardiography have enabled a more in-depth analysis of cardiac function in OSA patients. The LV global longitudinal strain (LV-GLS) is the most studied ST parameter, characterized by high reproducibility [10] and higher sensitivity in detecting subclinical LV systolic dysfunction, compared to biplane Simpson’s ejection fraction (EF) [11,12,13,14,15]

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Conclusion