The purpose of this study is to assess one month effects of oxygen (O2) and bilevel positive airway pressure (PAP) on sleep apnea, quality of life (QOL), cardiac function and sympathetic nervous activity in chronic (persistent and permanent) atrial fibrillation (AF).
We performed pulse oxymeter, nasal air flow sensor, chest and abdominal wall motion, and electrocardiogaphic monitoring system (TEIJIN, Morpheus C) during sleep, before (Control:C) and after one month of O2 (1M;O2) and bilevel PAP (1M;bilevel PAP) in 17 patients with chronic AF and oxygen desaturation index (ODI)4%≥ 5/h by nocturnal pulse oxymeter. New York Heart Association (NYHA) functional class and minimum symptom appearing activity (METs) by specific activity scale, Epworth sleepiness scale, chest rentogenogram, Doppler echocardiography, and serum and urinary noradrenaline level were compared befor (C) and after one month of O2 and bilevel PAP.
Apnea hypopnea index (AHI;/h) improved from 22(C) to 12 (1M;O2) and 7 (1M;bilevel PAP). Central apnea index (CAI;/h) decreased from 7.5(C) to 3.2 (1M;O2) and 0.1 (1M;bilevel PAP). Urinary noradrenaline decreased from 1.1(C) to 0.9 (1M;O2) and 0.9 (1M;bilevel PAP). Mean heart rate reduced from 64 (C) to 60 (1M;O2) and 59 (1M;bilevel PAP). NYHA functional class, minimum symptom appearing activity and Epworth sleepiness scale improved from 2.5;4.3;9.5 (C) to 2.0; 4.9; 6.4 (1M;O2) and 1.9; 5.3; 5.9 (1M;bilevel PAP), respectively. Cardiothoracic ratio (%) decresed from 58(C) to 55(1M;O2) and 56 (1M;bilevel PAP). Left atrial dimension, left ventricular diastolic and systolic dimension (mm) decreased from 51;53;32(C) to 49;51:30(1M;O2) and 49;50;30(1M;bilevel PAP), respectively, and right ventricular systolic pressure (mmHg) calculated from tricuspid regurgitation with continuous wave Doppler decreased from 50(C) to 41 (1M;O2) and 44(1M;bilevel PAP).
These results suggest that one month of O2 and bilevel PAP therapy may be useful for improving sleep apnea, QOL, sympathetic nervous activity and cardiac function in patients with chronic AF. The belevel PAP was more effective than O2.
One month of O2 and bilevel PAP may be the useful therapy for chronic AF, and bilevel PAP is superior to O2.
Hitoshi Koito, No Financial Disclosure Information; No Product/Research Disclosure Information