PURPOSE:To study the effect of nocturnal continuous positive airway pressure (CPAP) therapy on improvement in left ventricular ejection fraction (LVEF) in patients with systolic congestive heart failure(CHF) and obstructive sleep apnea (OSA).
METHODS:The authors searched MEDLINE and reviewed citations of all original articles and reviews for studies published in English. Only randomized controlled trials studying the effect of nocturnal CPAP therapy on LVEF in patients with both systolic heart failure and OSA were eligible for inclusion in the metanalysis. Data was analyzed using Medcalc statistical software. The Mantel-Haenszel method for calculating the weighted summary odds ratio under the fixed effects model was used for statistical analysis. Next the heterogeneity statistic was incorporated to calculate the summary odds ratio under the random effects model.
RESULTS:Two randomized controlled trials were considered eligible for inclusion in the analysis. Total number of OSA+CHF patients treated with nocturnal CPAP therapy was 40. The number of patients in this group with significant improvement in LVEF was 37 (92.5%). Total number of patients in the control group (OSA+CHF patients treated with conservative treatment only, without CPAP) was 39. The number of patients in the control group with significant improvement in LVEF was 17 (43.6%). The number of patients with improvement in LVEF was significantly higher in the group receiving CPAP therapy (92.5% vs. 43.6%, p<0.001). After performing metanalysis, the combined odds ratio for improvement in LVEF by CPAP therapy in OSA+systolic CHF patients was 11.68 (95% confidence interval = 3.55 to 38.44) by fixed effect model. The test for heterogeneity was non-significant (p=0.15).
CONCLUSION:Nocturnal CPAP therapy significantly improves LVEF in patients with both OSA and systolic CHF. Larger randomized controlled studies done for longer duration may help to show if the improvement in LVEF by CPAP therapy translates to improved survival and improved health-related quality of life.
CLINICAL IMPLICATIONS:Nocturnal CPAP may improve LVEF in patients with systolic CHF and OSA.
DISCLOSURE:Bhavneesh Sharma, No Financial Disclosure Information; No Product/Research Disclosure Information