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Effects of Short-Term Continuous Positive Airway Pressure on Myocardial Sympathetic Nerve Function and Energetics in Patients With Heart Failure and Obstructive Sleep Apnea: A Randomized Study
Study Questions:
In patients with obstructive sleep apnea (OSA) and heart failure with reduced ejection fraction (HFrEF), what is the impact on myocardial energetics and sympathetic nervous system (SNS) activation of short-term treatment of OSA by nocturnal continuous positive airway pressure (CPAP)?
Methods:
This was a single-center, unblinded, randomized controlled trial in which 45 eligible patients were randomly assigned to CPAP or no CPAP therapy. Participants underwent baseline echocardiography, 11C-acetate imaging to determine cardiac work-metabolic index, and 11C-hydroxyephedrine (HED) positron emission tomography to determine synaptic sympathetic neuron function.
Results:
A significant increase in 11C-HED retention occurred with the CPAP arm compared to the non-CPAP arm (p = 0.003). Although there was a trend toward a positive change in the work-metabolic index in the CPAP arm, compared to the non-CPAP arm, this did not meet statistical significance (p = 0.574).
Conclusions:
Short-term CPAP therapy in patients with HFrEF and OSA improves myocardial sympathetic dysregulation, as signified by an increase in 11C-HED retention. CPAP therapy did not improve myocardial energetics.
Perspective:
This is an important study that highlights the value of short-term CPAP in those with HFrEF. Although the authors did not observe a statistically significant increase in left ventricular EF (LVEF) with CPAP (as others have reported), the mean LVEF in the present study (35.8%) was not as severely depressed as in other studies. While it is interesting that short-term CPAP improves HED retention, the significance of this is unclear. Larger studies with clinical endpoints will help further elucidate the value of CPAP in those with (and without) OSA in HFrEF.
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