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Diuretics in Obstructive Sleep Apnea With Diastolic Heart Failure^*

^* From the Department of Biomedical Sciences and Human Oncology (Drs. Bucca, Brussino, Battisti, and Rolla); Sleep Medicine Center (Dr. Mutani and Cicolin), Department of Neurosciences; and Department of Internal Medicine (Dr. Mangiardi), University of Turin, Turin, Italy.

Correspondence to: Caterina Bucca, MD, FCCP, Department of Biomedical Sciences and Human Oncology, University of Turin, Via Lamarmora 41, 10128 Turin, Italy; e-mail: caterina.bucca{at}unito.it

Abstract

Background: Upper airway edema might contribute to pharyngeal collapsibility and account for the high prevalence of obstructive sleep apnea (OSA) in patients with heart disease. The aim of this study was to evaluate if intensive unloading with diuretics improves sleep-disordered breathing and increases pharyngeal caliber in patients with severe OSA and diastolic heart failure.

Methods: Fifteen patients with severe OSA, hypertension, and diastolic heart failure were hospitalized to receive IV furosemide, 20 mg, and spironolactone, 100 mg, bid for 3 days. Polysomnography was performed for assessment of apnea-hypopnea index (AHI), acoustic pharyngometry was performed for assessment of the oropharyngeal junction (OPJ) area, and forced midinspiratory flow (FIF₅₀), forced midexpiratory flow (FEF₅₀)/FIF₅₀ percentage, and exhaled nitric oxide (FeNO) were measured before and after diuretic treatment.

Results: Diuretic treatment produced a significant decrease in body weight, BP, and AHI (from 74.89 ± 6.95 to 57.17 ± 5.40/h, p < 0.001), associated with an improvement in OPJ area (from 1.33 ± 0.10 to 1.78 ± 0.16 cm², p = 0.007), FIF₅₀ (from 3.16 ± 0.4 to 3.94 ± 0.4 L/s, p = 0.006), and FEF₅₀/FIF₅₀ percentage (from 117.9 ± 11.8 to 93.15 ± 10.1%, p = 0.002). Weight loss was significantly related to the decrease of AHI (R = 0.602; p = 0.018), to the increase of FIF₅₀ (R = 0.68; p = 0.005), and to the decrease of FEF₅₀/FIF₅₀ (R = 0.635; p = 0.011).

Conclusions: These findings suggest that pharyngeal edema contributes to sleep-disordered breathing in obese patients with severe OSA, hypertension, and diastolic heart failure. Upper airway edema may contribute to the frequent occurrence of OSA in patients with heart disease.

Key Words: acoustic pharyngometry • exhaled nitric oxide • inspiratory flows • pharyngeal edema