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Clinical Investigations: SLEEP AND BREATHING |

Left Ventricular Hypertrophy Is a Common Echocardiographic Abnormality in Severe Obstructive Sleep Apnea and Reverses With Nasal Continuous Positive Airway Pressure*

Tom V. Cloward; James M. Walker; Robert J. Farney; Jeffrey L. Anderson
Author and Funding Information

*From the Intermountain Sleep Disorders Center (Drs. Cloward, Walker, and Farney), LDS Hospital; and Division of Cardiology (Dr. Anderson), University of Utah, Salt Lake City, UT.

Correspondence to: Tom V. Cloward, MD, FCCP, Intermountain Sleep Disorders Center, LDS Hospital, Eighth Ave and C St, Salt Lake City, UT 84143; e-mail: ldtclowa@ihc.com



Chest. 2003;124(2):594-601. doi:10.1378/chest.124.2.594
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Study objectives: To determine cardiac structural abnormalities by echocardiography in subjects with severe obstructive sleep apnea (OSA), and to determine the long-term effects of nasal continuous positive airway pressure (CPAP) on such abnormalities.

Design: Polysomnography was conducted on oximetry-screened patients who showed a desaturation index > 40/h and ≥ 20% cumulative time spent below 90%. From these, 25 patients with severe OSA but without daytime hypoxemia underwent echocardiography prior to, then 1 month and 6 months following initiation of CPAP treatment.

Setting: Outpatient sleep disorders center.

Results: Of the 25 patients, 13 patients (52%) had hypertension by history or on physical examination. Baseline echocardiograms showed that severe OSA was associated with numerous cardiovascular abnormalities, including left ventricular hypertrophy (LVH) [88%], left atrial enlargement (LAE) [64%], right atrial enlargement (RAE) [48%], and right ventricular hypertrophy (16%). In all patients (intent to treat) as well as those patients compliant with CPAP therapy (84% > 3 h nightly), there was a significant reduction in LVH after 6 months of CPAP therapy as measured by interventricular septal distance (baseline diastolic mean, 13.0 mm; 6-month mean after CPAP, 12.3 mm; p < 0.02). RAE and LAE were unchanged after CPAP therapy.

Conclusions: LVH was present in high frequency in subjects with severe OSA and regressed after 6 months of nasal CPAP therapy.

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