Impact of continuous positive airway pressure treatment on right ventricle performance in patients with obstructive sleep apnoea, assessed by three-dimensional echocardiography

Abstract

Background: Obstructive sleep apnoea (OSA) is a predictor of right ventricle (RV) impairment. However, there is scant information on the effect of OSA treatment on RV performance. We sought to evaluate the impact of OSA treatment with a continuous positive airway pressure (CPAP) device on RV volume and function, as well as on variables related to pulmonary vascular haemodynamics.Methods: Fifty-six OSA patients and 50 controls were studied. All individuals underwent three-dimensional echocardiogram (3DE) to estimate RV volumes, function, pulmonary vascular resistance, and tricuspid regurgitation velocity. A total of 30 patients with apnoea-hypopnoea index greater than 20 were randomly selected to receive placebo (n = 15) or effective CPAP (n = 15) for 24 weeks. They underwent 3DE examination on three different occasions: at baseline, after 12 weeks, and after 24 weeks of CPAP or placebo.Results: Higher pulmonary vascular resistance (2.1 Wood's +/- 0.5 vs. 1.8 Wood's +/- 0.4), larger end-diastolic RV volume index (52.2 mL/m(2) +/- 7.3 vs. 49.9 mL/m(2) +/- 6.0), larger end-systolic RV volume index (18.7 mL/m(2) +/- 4.3 vs. 15.4 mL/m(2) +/- 3.6), and lower RV ejection fraction (64.3% +/- 6.8 vs. 68.4% +/- 5.9) were observed in the OSA group compared to non-OSA controls (P < 0.05, all). in the effective CPAP group we observed the following changes from the baseline to the 24-week echo evaluation: (A) reduction in pulmonary vascular resistance (2.2 Wood's +/- 0.3 to 1.8 Wood's +/- 0.3); (B) reduction in the RV end-systolic volume index (20.3 mL/m(2) +/- 4.5 to 16 mL/m(2) +/- 2.1); and (C) increase in RV ejection fraction (63.0% +/- 7.2 to 70.8% +/- 0.9) (P < 0.05 for all).Conclusion: Twenty-four-week treatment with CPAP improved RV performance but did not change RV structural variables. (C) 2012 Elsevier B. V. All rights reserved.Universidade Federal de São Paulo, Dept Cardiol, BR-04516001 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Psychobiol, BR-04516001 São Paulo, BrazilAlbert Einstein Hosp, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Cardiol, BR-04516001 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Psychobiol, BR-04516001 São Paulo, BrazilWeb of ScienceFundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)CEPIDAFI