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SLEEP DISORDERED BREATHING |
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
Correspondence to:
Correspondence to:
Dr T D Bradley
Toronto General Hospital/University Health Network, EC 6-248, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada; douglas.bradley{at}utoronto.ca
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.
Abbreviations: 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
Keywords: heart failure; sleep apnoea; urinary norepinephrine; ventricular ectopy
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