Effects of Exercise Training and CPAP in Patients With Heart Failure and OSA: A Preliminary Study.

BACKGROUND: Exercise and CPAP improve OSA. This study examined the effects of exercise in patients with heart failure (HF) and OSA. METHODS: Patients with HF and OSA were randomized to the following study groups: control, exercise, CPAP, and exercise + CPAP. RESULTS: Sixty-five participants completed the protocol. Comparing baseline vs 3 months, the mean apnea-hypopnea index (AHI) did not change significantly (in events per hour) in the control group, decreased moderately in the exercise group (28 ± 17 to 18 ± 12; P < .03), and decreased significantly more in the CPAP group (32 ± 25 to 8 ± 11; P < .007) and in the exercise + CPAP group (25 ± 15 to 10 ± 16; P < .007). Peak oxygen consumption, muscle strength, and endurance improved only with exercise. Both exercise and CPAP improved subjective excessive daytime sleepiness, quality of life, and the New York Heart Association functional class. However, compared with the control group, changes in scores on the 36-item Medical Outcomes Study Short Form Survey and Minnesota Living with Heart Failure Questionnaire were only significant in the exercise groups. CONCLUSIONS: In patients with HF and OSA, our preliminary results showed that exercise alone attenuated OSA and improved quality of life more than CPAP. In the landscape treatment of OSA in patients with HF, this analysis is the only randomized trial showing any treatment (in this case, exercise) that improved all the studied parameters. The results highlight the important therapeutic benefits of exercise, particularly because adherence to CPAP is low.

Left Atrial Volume Determinants in Patients with Non-Ischemic Dilated Cardiomyopathy / Determinantes do Volume do Átrio Esquerdo em Pacientes com Cardiomiopatia Dilatada Não Isquêmica

Left atrial volume (LAV) is a predictor of prognosis in patients with heart failure.

O Volume do Átrio Esquerdo (VAE) é preditor prognóstico em pacientes com insuficiência cardíaca.

Left Atrial Volume Determinants in Patients with Non-Ischemic Dilated Cardiomyopathy.

BACKGROUND: Left atrial volume (LAV) is a predictor of prognosis in patients with heart failure. OBJECTIVE: We aimed to evaluate the determinants of LAV in patients with dilated cardiomyopathy (DCM). METHODS: Ninety patients with DCM and left ventricular (LV) ejection fraction ≤ 0.50 were included. LAV was measured with real-time three-dimensional echocardiography (eco3D). The variables evaluated were heart rate, systolic blood pressure, LV end-diastolic volume and end-systolic volume and ejection fraction (eco3D), mitral inflow E wave, tissue Doppler e' wave, E/e' ratio, intraventricular dyssynchrony, 3D dyssynchrony index and mitral regurgitation vena contracta. Pearson's coefficient was used to identify the correlation of the LAV with the assessed variables. A multiple linear regression model was developed that included LAV as the dependent variable and the variables correlated with it as the predictive variables. RESULTS: Mean age was 52 ± 11 years-old, LV ejection fraction: 31.5 ± 8.0% (16-50%) and LAV: 39.2±15.7 ml/m2. The variables that correlated with the LAV were LV end-diastolic volume (r = 0.38; p < 0.01), LV end-systolic volume (r = 0.43; p < 0.001), LV ejection fraction (r = -0.36; p < 0.01), E wave (r = 0.50; p < 0.01), E/e' ratio (r = 0.51; p < 0.01) and mitral regurgitation (r = 0.53; p < 0.01). A multivariate analysis identified the E/e' ratio (p = 0.02) and mitral regurgitation (p = 0.02) as the only independent variables associated with LAV increase. CONCLUSION: The LAV is independently determined by LV filling pressures (E/e' ratio) and mitral regurgitation in DCM.

Sleep Apnea and Nocturnal Cardiac Arrhythmia: A Populational Study / Apneia do Sono e Arritmia Cardíaca Noturna: Estudo Populacional

Background: The mechanisms associated with the cardiovascular consequences of obstructive sleep apnea include abrupt changes in autonomic tone, which can trigger cardiac arrhythmias. The authors hypothesized that nocturnal cardiac arrhythmia occurs more frequently in patients with obstructive sleep apnea. Objective: To analyze the relationship between obstructive sleep apnea and abnormal heart rhythm during sleep in a population sample. Methods: Cross-sectional study with 1,101 volunteers, who form a representative sample of the city of São Paulo. The overnight polysomnography was performed using an EMBLA® S7000 digital system during the regular sleep schedule of the individual. The electrocardiogram channel was extracted, duplicated, and then analyzed using a Holter (Cardio Smart®) system. Results: A total of 767 participants (461 men) with a mean age of 42.00 ± 0.53 years, were included in the analysis. At least one type of nocturnal cardiac rhythm disturbance (atrial/ventricular arrhythmia or beat) was observed in 62.7% of the sample. The occurrence of nocturnal cardiac arrhythmias was more frequent with increased disease severity. Rhythm disturbance was observed in 53.3% of the sample without breathing sleep disorders, whereas 92.3% of patients with severe obstructive sleep apnea showed cardiac arrhythmia. Isolated atrial and ventricular ectopy was more frequent in patients with moderate/severe obstructive sleep apnea when compared to controls (p < 0.001). After controlling for potential confounding factors, age, sex and apnea-hypopnea index were associated with nocturnal cardiac arrhythmia. Conclusion: Nocturnal cardiac arrhythmia occurs more frequently in patients with obstructive sleep apnea and the prevalence increases with disease severity. Age, sex, and the Apnea-hypopnea index were predictors of arrhythmia in this sample. .

Fundamento: Os mecanismos relacionados às consequências cardiovasculares da apneia obstrutiva do sono incluem modificações abruptas no tônus autonômico, que podem desencadear arritmias cardíacas. Os autores tiveram como hipótese a ocorrência de arritmias cardíacas noturnas maiores em pacientes portadores de apneia obstrutiva do sono. Objetivo: Analisar a relação entre a apneia obstrutiva do sono e o registro de anormalidade no ritmo cardíaco, durante o sono, em uma amostra populacional. Métodos: Estudo transversal com uma amostra representativa da cidade de São Paulo de 1.101 voluntários. A polissonografia de noite inteira foi realizada por meio de um sistema digital (EMBLA® S7000), durante o horário regular de sono do indivíduo. O canal de eletrocardiograma foi extraído, duplicado e, em seguida, analisado com um sistema Holter (Cardio Smart®). Resultados: Um total de 767 participantes, sendo 461 do sexo masculino, com idade média de 42,00 ± 0,53 anos, foi incluído nas análises. Pelo menos um tipo de distúrbio do ritmo cardíaco noturno (arritmia atrial/ventricular ou pausa) foi observado em 62,7% da amostra. A ocorrência de arritmias cardíacas noturnas foi mais frequente com o aumento da gravidade da doença. A perturbação do ritmo foi observada em 53,3% da amostra sem distúrbios respiratórios do sono, enquanto que 92,3% dos pacientes com grave apneia obstrutiva do sono apresentaram arritmia cardíaca. Ectopia atrial e ventricular isolada foi mais frequente em pacientes com apneia obstrutiva do sono moderada/severa quando comparada com controles (p < 0,001). Após controle de potenciais fatores de confusão, idade, sexo e Índice de Apneia-Hipopneia foram associados à arritmia cardíaca noturna. Conclusão: Arritmias cardíacas ...

Sleep Apnea and Nocturnal Cardiac Arrhythmia: A Populational Study.

Background: The mechanisms associated with the cardiovascular consequences of obstructive sleep apnea include abrupt changes in autonomic tone, which can trigger cardiac arrhythmias. The authors hypothesized that nocturnal cardiac arrhythmia occurs more frequently in patients with obstructive sleep apnea. Objective: To analyze the relationship between obstructive sleep apnea and abnormal heart rhythm during sleep in a population sample. Methods: Cross-sectional study with 1,101 volunteers, who form a representative sample of the city of São Paulo. The overnight polysomnography was performed using an EMBLA® S7000 digital system during the regular sleep schedule of the individual. The electrocardiogram channel was extracted, duplicated, and then analyzed using a Holter (Cardio Smart®) system. Results: A total of 767 participants (461 men) with a mean age of 42.00 ± 0.53 years, were included in the analysis. At least one type of nocturnal cardiac rhythm disturbance (atrial/ventricular arrhythmia or beat) was observed in 62.7% of the sample. The occurrence of nocturnal cardiac arrhythmias was more frequent with increased disease severity. Rhythm disturbance was observed in 53.3% of the sample without breathing sleep disorders, whereas 92.3% of patients with severe obstructive sleep apnea showed cardiac arrhythmia. Isolated atrial and ventricular ectopy was more frequent in patients with moderate/severe obstructive sleep apnea when compared to controls (p < 0.001). After controlling for potential confounding factors, age, sex and apnea-hypopnea index were associated with nocturnal cardiac arrhythmia. Conclusion: Nocturnal cardiac arrhythmia occurs more frequently in patients with obstructive sleep apnea and the prevalence increases with disease severity. Age, sex, and the Apnea-hypopnea index were predictors of arrhythmia in this sample.