Improvements of Right Ventricular Function After Intervention with CPAP in Patients with Obstructive Sleep Apnoea

Overview

Journal Echo Res Pract

Date 2024 Oct 1

PMID 39350267

Authors

Greg Murphy

Peter Coss

Gerard King

Mark Coyle

Anne-Marie McLaughlin

Ross Murphy

Affiliations

Soon will be listed here.

Abstract

Background: Obstructive sleep apnoea (OSA) is present in 40-80% of patients with cardiovascular morbidity and is associated with adverse effects on cardiovascular health. Continuous positive airway pressure (CPAP) maintains airway patency during sleep and is hypothesised to improve cardiac function. In the present study, we report on the impact of 12 weeks of CPAP and improvements in echocardiographic parameters of the right ventricle (RV).

Methods: Nineteen newly diagnosed patients with OSA and a respiratory disturbance index (RDI) greater than 10 were enrolled. Echocardiography was performed before treatment and with a follow-up assessment after 12 weeks of CPAP. Echocardiographic and Doppler measurements were made following the American Society for Echocardiography guidelines. The primary outcome was isovolumetric acceleration (IVA). Secondary outcomes include tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC), RV % strain, TEI index and RV dimension (RVD1).

Results: There was significant improvement in isovolumetric acceleration of 0.5ms (P = 0.0012 (95% CI -0.72, -0.20)) and significant improvement of 2.05 mm in TAPSE (p = 0.0379 (95% CI -3.98 - -0.13). There was no significant difference in FAC, RV % strain, TEI index or RVD1 with twelve weeks of CPAP therapy.

Conclusion: The present study highlights significant improvement in TAPSE and IVA with 12 weeks of CPAP treatment and no significant improvement in FAC, RVD1 and RV % strain. These data indicate favourable characteristics on both load dependent and load independent markers of RV function with CPAP.

References

Vogel M, Schmidt M, Kristiansen S, Cheung M, White P, Sorensen K . Validation of myocardial acceleration during isovolumic contraction as a novel noninvasive index of right ventricular contractility: comparison with ventricular pressure-volume relations in an animal model. Circulation. 2002; 105(14):1693-9. DOI: 10.1161/01.cir.0000013773.67850.ba. View

Lu M, Wang Z, Zhan X, Wei Y . Obstructive sleep apnea increases the risk of cardiovascular damage: a systematic review and meta-analysis of imaging studies. Syst Rev. 2021; 10(1):212. PMC: 8325188. DOI: 10.1186/s13643-021-01759-6. View

Mansukhani M, Wang S, Somers V . Chemoreflex physiology and implications for sleep apnoea: insights from studies in humans. Exp Physiol. 2014; 100(2):130-5. PMC: 4439216. DOI: 10.1113/expphysiol.2014.082826. View

Korcarz C, Peppard P, Young T, Chapman C, Hla K, Barnet J . Effects of Obstructive Sleep Apnea and Obesity on Cardiac Remodeling: The Wisconsin Sleep Cohort Study. Sleep. 2016; 39(6):1187-95. PMC: 4863205. DOI: 10.5665/sleep.5828. View

Javaheri S, Barbe F, Campos-Rodriguez F, Dempsey J, Khayat R, Javaheri S . Sleep Apnea: Types, Mechanisms, and Clinical Cardiovascular Consequences. J Am Coll Cardiol. 2017; 69(7):841-858. PMC: 5393905. DOI: 10.1016/j.jacc.2016.11.069. View

Peppard P, Young T, Palta M, Skatrud J . Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med. 2000; 342(19):1378-84. DOI: 10.1056/NEJM200005113421901. View

Sanner B, Konermann M, Sturm A, Muller H, Zidek W . Right ventricular dysfunction in patients with obstructive sleep apnoea syndrome. Eur Respir J. 1997; 10(9):2079-83. DOI: 10.1183/09031936.97.10092079. View

Vogel M, Cheung M, Li J, Kristiansen S, Schmidt M, White P . Noninvasive assessment of left ventricular force-frequency relationships using tissue Doppler-derived isovolumic acceleration: validation in an animal model. Circulation. 2003; 107(12):1647-52. DOI: 10.1161/01.CIR.0000058171.62847.90. View

Vignola P, Bloch A, Kaplan A, Walker H, Chiotellis P, MYERS G . Interobserver variability in echocardiography. J Clin Ultrasound. 1977; 5(4):238-42. DOI: 10.1002/jcu.1870050405. View

10.

Arias M, Garcia-Rio F, Alonso-Fernandez A, Mediano O, Martinez I, Villamor J . Obstructive sleep apnea syndrome affects left ventricular diastolic function: effects of nasal continuous positive airway pressure in men. Circulation. 2005; 112(3):375-83. DOI: 10.1161/CIRCULATIONAHA.104.501841. View

11.

Rodriguez-Arias J, Ortega-Paz L, Brugaletta S . Durable polymer everolimus-eluting stents: history, current status and future prospects. Expert Rev Med Devices. 2020; 17(7):671-682. DOI: 10.1080/17434440.2020.1784005. View

12.

Peker Y, Carlson J, Hedner J . Increased incidence of coronary artery disease in sleep apnoea: a long-term follow-up. Eur Respir J. 2006; 28(3):596-602. DOI: 10.1183/09031936.06.00107805. View

13.

Sabba C, Merkel C, Zoli M, Ferraioli G, Gaiani S, Sacerdoti D . Interobserver and interequipment variability of echo-Doppler examination of the portal vein: effect of a cooperative training program. Hepatology. 1995; 21(2):428-33. DOI: 10.1002/hep.1840210225. View

14.

Rotenberg B, Murariu D, Pang K . Trends in CPAP adherence over twenty years of data collection: a flattened curve. J Otolaryngol Head Neck Surg. 2016; 45(1):43. PMC: 4992257. DOI: 10.1186/s40463-016-0156-0. View

15.

Arnaud C, Bochaton T, Pepin J, Belaidi E . Obstructive sleep apnoea and cardiovascular consequences: Pathophysiological mechanisms. Arch Cardiovasc Dis. 2020; 113(5):350-358. DOI: 10.1016/j.acvd.2020.01.003. View

16.

Guazzi M, Dixon D, Labate V, Beussink-Nelson L, Bandera F, Cuttica M . RV Contractile Function and its Coupling to Pulmonary Circulation in Heart Failure With Preserved Ejection Fraction: Stratification of Clinical Phenotypes and Outcomes. JACC Cardiovasc Imaging. 2017; 10(10 Pt B):1211-1221. DOI: 10.1016/j.jcmg.2016.12.024. View

17.

Damy T, Kallvikbacka-Bennett A, Goode K, Khaleva O, Lewinter C, Hobkirk J . Prevalence of, associations with, and prognostic value of tricuspid annular plane systolic excursion (TAPSE) among out-patients referred for the evaluation of heart failure. J Card Fail. 2012; 18(3):216-25. DOI: 10.1016/j.cardfail.2011.12.003. View

18.

Marin J, Carrizo S, Vicente E, Agusti A . Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet. 2005; 365(9464):1046-53. DOI: 10.1016/S0140-6736(05)71141-7. View

19.

Ernande L, Cottin V, Leroux P, Girerd N, Huez S, Mulliez A . Right isovolumic contraction velocity predicts survival in pulmonary hypertension. J Am Soc Echocardiogr. 2012; 26(3):297-306. DOI: 10.1016/j.echo.2012.11.011. View

20.

Punjabi N . The epidemiology of adult obstructive sleep apnea. Proc Am Thorac Soc. 2008; 5(2):136-43. PMC: 2645248. DOI: 10.1513/pats.200709-155MG. View