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Effect of continuous positive airway pressure on ventricular ectopy in heart failure patients with obstructive sleep apnoea
  1. C M Ryan,
  2. K Usui,
  3. J S Floras,
  4. T D Bradley
  1. Sleep Research Laboratories, Mount Sinai Hospital and Toronto Rehabilitation Institute, and the Centre for Sleep Medicine and Circadian Biology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
  1. Correspondence to:
    Dr T D Bradley
    Toronto General Hospital/University Health Network, EC 6-248, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada; douglas.bradleyutoronto.ca

Abstract

Background: Obstructive sleep apnoea (OSA) elicits a number of cardiovascular perturbations that could lead acutely or chronically to increased ventricular ectopy in patients with heart failure (HF). We tested the hypothesis that treatment of OSA with continuous positive airway pressure (CPAP) in patients with HF would reduce the frequency of ventricular premature beats (VPBs) during sleep in association with reduced sympathetic nervous system activity.

Methods: Following optimisation of medical treatment, 18 HF patients with OSA and >10 VPBs per hour of sleep were randomised to a control group (n = 8) or a treatment group who received CPAP (n = 10). The frequency of VPBs and urinary norepinephrine (noradrenaline) concentrations during total sleep time were determined at baseline and after 1 month.

Results: Control patients did not experience any significant changes in apnoea-hypopnoea index (AHI), mean nocturnal O2 saturation, or the frequency of VPBs. In contrast, there was a significant reduction in AHI (p<0.001), an increase in minimum O2 saturation (p = 0.05), a reduction in urinary norepinephrine concentrations (p = 0.009), and a 58% reduction in the frequency of VPBs during total sleep (from mean (SE) 170 (65) to 70 (28) per hour, p = 0.011) after 1 month of CPAP treatment.

Conclusions: In patients with HF, treatment of co-existing OSA by CPAP reduces the frequency of VPBs during sleep. These data suggest that reductions in VPBs and other ventricular arrhythmias through treatment of OSA might improve the prognosis in patients with HF.

  • AHI, apnoea-hypopnoea index
  • CPAP, continuous positive airways pressure
  • HF, heart failure
  • LVEF, left ventricular ejection fraction
  • OSA, obstructive sleep apnoea
  • VPB, ventricular premature beat
  • heart failure
  • sleep apnoea
  • urinary norepinephrine
  • ventricular ectopy

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Footnotes

  • Published Online First 30 June 2005

  • This study was supported by operating grant MOP-11607 from the Canadian Institutes of Health Research (CIHR). CMR is supported by research fellowships from Respironics Inc and the Toronto Rehabilitation Institute, KU by a research fellowship from Respironics Inc, JSF by the Canada Research Chair in Integrative Cardiovascular Biology and a Career Investigator Award from the Heart and Stroke Foundation of Ontario, and TDB by a Senior Scientist Award from the CIHR.

  • Competing interests: CMR and KU received research fellowship funding from Respironics Inc, and JSF and TDB have received research funding for an unrelated clinical trial involving heart failure patients with central sleep apnoea from Respironics Inc, ResMed Inc, and Tyco Healthcare Inc.