Estudo prospectivo randomizado do efeito do tratamento com pressão positiva da via aérea sobre a função cardiovascular em pacientes com apneia obstrutiva do sono e hipertensão arterial sistêmica resistente

Abstract

Obstructivesleepapnea (OSA) isaprevalentcondition, particularly in patientswithresistanthypertension (RH). The use of continuous positive airway pressure (CPAP) can reduce blood pressure in these patients. Cardiovascular complications are common in patients with OSA and can be lowered by CPAP. However, it is not clear how OSA influences cardiac changes in patients with RH. For the purpose of evaluating effects of treatment of OSA on cardiac performance, 69 patients with RH and OSA confirmed by polysomnography (36 men; age ± SD = 57.7±12.2 yr.)were randomly separated into two groups: patients treated only with antihypertensive drugs (n = 32) and patients with antihypertensive drugs and CPAP. The drug treatment was maintained in all cases. The two groups underwent echocardiographic assessment at baseline and after three months. Left ventricular ejection fraction increased(65.5±5.0% vs 67.3±4.6%), systolic pulmonary artery pressure (31.7±5.5 mmHg vs 28.3±2.6 mmHg) and right ventricle diameter (19.4±3.7 mm vs 17.8±3.3 mm) reduced in patients treated with CPAP, but not in non-CPAP group. In conclusion, the study shows that the use of CPAP in patients with moderate to severe OSA and RH improves cardiac performance evaluated by Transthoracic Echocardiogram. New studies including a larger number of patients are needed to confirm the reduction in cardiovascular risk with treatment of OSA in patients with RH.