Effects of CPAP on cardiorespiratory outcomes in patients with obstructive sleep apnea and heart failure: a systematic review
DOI:
https://doi.org/10.1590/1809-2950/e23005623enKeywords:
Continuous Positive Airway Pressure, Obstructive Sleep Apnoea, Heart Failure, Systematic ReviewAbstract
Obstructive sleep apnea (OSA) is a public health problem with a great economic impact. It is estimated that the prevalence of patients with OSA ranges from 4% to 6% of men and 2% to 4% of women in the general population. Strong evidence suggests that both sleep disorders and heart failure (HF) are related. Continuous positive airway pressure (CPAP) is the gold standard non-pharmacological treatment for this population. However, there is still a gap in the literature and its effects in patients with OSA and HF are not entirely clear. This study aimed to evaluate, by randomized clinical trials, the effects of positive pressure on cardiorespiratory function in patients with OSA and HF. Randomized clinical trials were included, with publication in the MEDLINE, PEDro, Cochrane Library, SciELO and PubMed databases and the risk bias was assessed using the PEDro scale. Six articles were included in this study, involving 165 participants. Our findings demonstrate that CPAP in the treatment of OSA in patients with HF promotes an increase in left ventricular ejection fraction, oxygen saturation and a reduction in blood pressure, apnea/hypopnea indices and awakenings from sleep during the night. We conclude that treatment with CPAP promotes an improvement in cardiorespiratory outcomes in patients with OSA and HF, improving the prognosis and reducing the risk of sudden death. However, their data must be cautiously interpreted considering the bias of the studies and their limitations.
Downloads
References
Nerbass FB, Piccin VS, Peruchi BB, Mortari DM, Ykeda DS, et al. Atuação da Fisioterapia no tratamento dos distúrbios respiratórios do sono. ASSOBRAFIR Ciencia. 2015;6(2):13-30.
Benjamin JA, Lewis KE. Sleep-disordered breathing and cardiovascular disease. Postgrad Med J. 2008;84(987):15-22. doi: 10.1136/pgmj.2007.062836.
Pereira A. Síndrome da apneia obstrutiva do sono: fisiopatologia, epidemiologia, consequências, diagnóstico e tratamento. Arqui Med. 2007;21(5-6):159-73.
Thomas VB, Eibel B, Bordignon F, Barbosa E, Forgiarini LA Jr. Utilización de la presión positiva continua en las vías aéreas en la insuficiencia cardíaca y apnea obstructiva del sueño. Revisión sistemática de ensayos clínicos. Insuf Card. 2019;14(4):141-6.
Bradley TD, Floras JS. Obstructive sleep apnoea and its cardiovascular consequences. Lancet. 2009;373(9657):82-93. doi: 10.1016/S0140-6736(08)61622-0.
Javaheri S, Barbe F, Campos-Rodriguez F, Dempsey JA, Khayat R, et al. Sleep apnea: types, mechanisms, and clinical cardiovascular consequences. J Am Coll Cardiol. 2017;69(7):841-8.
Drager LF, McEvoy RD, Barbe F, Lorenzi-Filho G, Redline S. Sleep apnea and cardiovascular disease: lessons from recent trials and need for team science. Circulation. 2017;136(19):1840-50. doi: 10.1161/circulationaha.117.029400.
Kwon Y, Koene RJ, Johnson AR, Lin GM, Ferguson JD. Sleep, sleep apnea and atrial fibrillation: questions and answers. Sleep Med Rev. 2018;39:134-42. doi: 10.1016/j.smrv.2017.08.005. 9. Mosterd A, Hoes AW. Clinical epidemiology of heart failure. Heart. 2007;93(9):1137-46. doi: 10.1136/hrt.2003.025270.
Magalhães PAF, Cunha Neto JC, Capeleiro PB, Freitas KPN, Magalhães MGPA, et al. Ventilação não invasiva na insuficiência cardíaca associada à apneia do sono. Rev Bras Cienc Saude. 2015;19(1):61-6. doi: 10.4034/RBCS.2015.19.01.10.
Bordier P. Sleep apnoea in patients with heart failure: Part II: therapy. Arch Cardiovasc Dis. 2009;102(10):711-20. doi: 10.1016/j.acvd.2009.06.005.
Tserenpil G, Gebre M, Zergham AS, Sekhon AK, Malik BH. Managements for obstructive sleep apnea in adults: review. Cureus. 2020;12(8):e9905. doi: 10.7759/cureus.9905.
Galvão TF, Pansani TSA, Harrad D. Principais itens para relatar revisões sistemáticas e meta-análises: a recomendação PRISMA. Epidemiol Serv Saude. 2015;24(2):335-42. doi: 10.5123/S1679-49742015000200017.
Shiwa SR, Costa LOP, Moser ADL, Aguiar IC, Oliveira LVF. PEDro: a base de dados de evidências em fisioterapia. Fisioter Mov. 2011;24(3):523-33. doi: 10.1590/S0103-51502011000300017.
Pinto RZ, Maher CG, Ferreira ML, Hancock M, Oliveira VC, et al. Epidural corticosteroid injections in the management of sciatica: a systematic review and meta-analysis. Ann Intern Med. 2012;157(12):865-77. doi: 10.7326/0003-4819-157-12-201212180-00564.
Martini JD, Ferreira GE, Araujo FX. Pilates for neck pain: a systematic review and meta-analysis of randomised controlled trials. J Bodyw Mov Ther. 2022;31:37-44. doi: 10.1016/j.jbmt.2022.03.011. Fisioter Pesqui. 2023;30:e23005623pt8
Ryan CM, Usui K, Floras JS, Bradley TD. Effect of continuous positive airway pressure on ventricular ectopy in heart failure patients with obstructive sleep apnoea. Thorax. 2005;60(9):781-5. doi: 10.1136/thx.2005.040972.
Kaneko Y, Floras JS, Usui K, Plante J, Tkacova R, et al. Cardiovascular effects of continuous positive airway pressure in patients with heart failure and obstructive sleep apnea. N Engl J Med. 2003;348(13):1233-41. doi: 10.1056/NEJMoa022479.
Gilman MP, Floras JS, Usui K, Kaneko Y, Leung RS, et al. Continuous positive airway pressure increases heart rate variability in heart failure patients with obstructive sleep apnoea. Clin Sci (Lond). 2008;114(3):243-9. doi: 10.1042/CS20070172.
Ferrier KA, Neill AM, O’Meeghan T, Richards M, Campbell AJ. Continuous positive airway pressure in heart failure patients with obstructive sleep apnoea. Intern Med J. 2008;38(11):829-36. doi: 10.1111/j.1445-5994.2007.01585.x.
Mansfield DR, Gollogly NC, Kaye DM, Richardson M, Bergin P, et al. Controlled trial of continuous positive airway pressure in obstructive sleep apnea and heart failure. Am J Respir Crit Care Med. 2004;169(3):361-6. doi: 10.1164/rccm.200306-752OC. 22. Smith LA, Vennelle M, Gardner RS, McDonagh TA, Denvir MA, et al. Auto-titrating continuous positive airway pressure therapy in patients with chronic heart failure and obstructive sleep apnoea: a randomized placebo-controlled trial. Eur Heart J. 2007;28(10):1221-7. doi: 10.1093/eurheartj/ehm131.
Downloads
Published
Issue
Section
License
Copyright (c) 2023 Marcia da Silva Martins, Rafael Saldanha dos Santos, Francisco Xavier de Araujo
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
