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Beneficial Effect of Bilevel Positive Airway Pressure on Left Ventricular Function in Ambulatory Patients With Idiopathic Dilated Cardiomyopathy and Central Sleep Apnea-Hypopnea^*

A Preliminary Study

^* From Nagoya University School of Health Sciences (Drs. Noda, Nagata, and Koike), Department of Cardiology (Drs. Izawa, Asano, Hirashiki, Murase, and Murohara), and Department of Otorhinolaryngology (Dr. Nakata), Nagoya University Graduate School of Medicine; Department of Clinical Laboratory (Dr. Iino), Nagoya University Hospital; and Department of Cardiovascular Genome Science (Dr. Yokota), Nagoya University School of Medicine, Nagoya, Japan.

Correspondence to: Akiko Noda, PhD, Nagoya University School of Health Sciences, 1–1-20 Daiko, Minami, Higashi-ku, Nagoya, Aichi 461-8673, Japan; e-mail: a-noda{at}met.nagoya-u.ac.jp

Abstract

Background: Sleep-disordered breathing is common in individuals with left ventricular (LV) dysfunction and has been treated with nocturnal positive airway pressure. We investigated whether treatment of central sleep apnea-hypopnea with bilevel positive airway pressure (BPAP) in ambulatory patients with idiopathic dilated cardiomyopathy (IDCM) might improve LV function.

Methods: Fifty-two consecutive patients with IDCM who underwent both cardiac catheterization and standard polysomnography were enrolled in the study; individuals with obstructive sleep apnea syndrome were excluded. Subjects with an apnea-hypopnea index (AHI) 20 episodes per hour were randomized to receive medical therapy either alone (n = 11) or together with BPAP (n = 10).

Results: LV end-diastolic pressure, pulmonary capillary wedge pressure, and plasma concentration of brain natriuretic peptide were significantly greater, and LV ejection fraction (LVEF) was significantly lower in patients with an AHI 20/h (n = 21, 40.4%) than in those with an AHI < 20/h (n = 31, 59.6%). LVEF (30.5 ± 1.6% vs 50.8 ± 3.5%, p < 0.001) [mean ± SE] and plasma concentration of brain natriuretic peptide (162.8 ± 44.5 pg/mL vs 32.7 ± 17.6 pg/mL, p = 0.02) were significantly increased and decreased, respectively, after treatment with BPAP (daily use, 4.8 ± 0.3 h) for 3 months, whereas these parameters remained unchanged in the control subjects.

Conclusions: Our findings suggest that treatment of coexisting central sleep apnea-hypopnea with BPAP improves LV function in ambulatory patients with IDCM. BPAP should thus be considered as a nonpharmacologic adjunct to conventional drug therapy in such patients.

Key Words: bilevel positive airway pressure • cardiomyopathy • central sleep apnea • left ventricular function

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