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Title: Impact of continuous positive airway pressure treatment on right ventricle performance in patients with obstructive sleep apnoea, assessed by three-dimensional echocardiography
Authors: Oliveira, Wercules [UNIFESP]
Poyares, Dalva [UNIFESP]
Cintra, Fatima [UNIFESP]
Vieira, Marcelo L. C.
Fischer, Claudio H. [UNIFESP]
Moises, Valdir [UNIFESP]
Tufik, Sergio [UNIFESP]
Carvalho, Antonio [UNIFESP]
Campos, Orlando [UNIFESP]
Universidade Federal de São Paulo (UNIFESP)
Albert Einstein Hosp
Keywords: Cardiac remodeling
Obstructive sleep apnea
Three-dimensional echocardiography
Pulmonary hypertension
Systemic hypertension
Heart failure
Issue Date: 1-May-2012
Publisher: Elsevier B.V.
Citation: Sleep Medicine. Amsterdam: Elsevier B.V., v. 13, n. 5, p. 510-516, 2012.
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.
ISSN: 1389-9457
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