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Original Research: SLEEP DISORDERS |

Obstructive Sleep ApneaSleep Apnea and Cardiovascular Remodeling: Effects of Continuous Positive Airway Pressure on Cardiac Remodeling as Assessed by Cardiac Biomarkers, Echocardiography, and Cardiac MRI

Jane Colish, BSc; Jonathan R. Walker, MSc; Nader Elmayergi, MD; Saleh Almutairi, MD; Fawaz Alharbi, MD; Matthew Lytwyn, BSc; Andrew Francis, BSc; Sheena Bohonis, BSc; Matthew Zeglinski, BSc; Iain D. C. Kirkpatrick, MD; Sat Sharma, MD, FCCP; Davinder S. Jassal, MD
Author and Funding Information

From the Institute of Cardiovascular Sciences (Mss Colish and Bohonis; Messrs Walker, Lytwyn, Francis, and Zeglinski; and Dr Jassal), St. Boniface General Hospital; Section of Cardiology (Drs Elmayergi and Jassal) and Section of Respiratory Medicine (Drs Almutairi, Alharbi, and Sharma), Department of Internal Medicine; and Department of Radiology (Drs Kirkpatrick and Jassal), University of Manitoba, Winnipeg, MB, Canada.

Correspondence to: Davinder S. Jassal, MD, Rm Y3010, Bergen Cardiac Care Centre, Section of Cardiology, Department of Internal Medicine, St Boniface General Hospital, 409 Taché Ave, Winnipeg, Manitoba R2H 2A6, Canada; e-mail: djassal@sbgh.mb.ca


For editorial comment see page 580

Funding/Support: The present study was supported by the St. Boniface General Hospital and Research Foundation and the Manitoba Medical Services Foundation.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2012 American College of Chest Physicians


Chest. 2012;141(3):674-681. doi:10.1378/chest.11-0615
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Background:  Obstructive sleep apnea (OSA) is associated with an increased risk of cardiovascular morbidity and mortality. Although previous echocardiographic studies have demonstrated short-term improvement in cardiovascular remodeling in patients with OSA receiving continuous positive airway pressure (CPAP) therapy, a long-term study incorporating cardiac biomarkers, echocardiography, and cardiac MRI (CMR) has not been performed to date.

Methods:  A prospective study of 47 patients with OSA was performed between 2007 and 2010. Cardiac biomarkers, including C-reactive protein (CRP), N-terminal pro-B-type natriuretic peptide (NT-proBNP), and troponin T (TnT), were measured at baseline and serially over 1 year. All patients underwent baseline and serial transthoracic echocardiography (TTE) and CMR to assess cardiac remodeling.

Results:  Following 12 months of CPAP therapy, levels of CRP, NT-proBNP, and TnT did not change significantly from normal baseline values. As early as 3 months after initiation of CPAP, TTE revealed an improvement in right ventricular end-diastolic diameter, left atrial volume index, right atrial volume index, and degree of pulmonary hypertension, which continued to improve over 1 year of follow-up. Finally, left ventricular mass, as determined by CMR, decreased from 159 ± 12 g/m2 to 141 ± 8 g/m2 as early as 6 months into CPAP therapy and continued to improve until completion of the study at 1 year.

Conclusion:  Both systolic and diastolic abnormalities in patients with OSA can be reversed as early as 3 months into CPAP therapy, with progressive improvement in cardiovascular remodeling over 1 year as assessed by both TTE and CMR.

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