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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, Nagoya, Japan (A. Noda, K. Nagata, Y. Koike); Department of Cardiology (H. Izawa, H. Asano, A. Hirashiki, Y. Murase, T. Murohara) and Department of Otorhinolaryngology (S. Nakata), Nagoya University Graduate School of Medicine, Nagoya, Japan; Department of Clinical Laboratory, Nagoya University Hospital, Nagoya, Japan (S. Iino); and Department of Cardiovascular Genome Science, Nagoya University School of Medicine, Nagoya, Japan (M. Yokota)

a-noda{at}met.nagoya-u.ac.jp

Abstract

BackgroundSleep-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 (BiPAP) in ambulatory patients with idiopathic dilated cardiomyopathy (IDCM) might improve LV function.

MethodsFifty-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) of 20 episodes per hour were randomized to receive medical therapy either alone (n = 11) or together with BiPAP (n = 10).

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

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

Clinical trials registry (https//register.clinicaltrials.gov) no.: NU-06-A-0002.

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

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