Positive Airway Pressure Therapy Reduces Pulmonary Hypertension in Patients Admitted for Acute Heart Failure with Pulmonary Hypertension and Obstructive Sleep Apnea. The ASAP-HF Pilot Trial.

Abstract

Pulmonary hypertension(PH) is extremely common in acute decompensated heart failure (ADHF) patients and predicts increased mortality. Obstructive sleep apnea (OSA) is highly prevalent in CHF patients, may contribute to further elevated pulmonary pressures.\n\n\nOBJECTIVES\nThis study evaluates the impact of positive airway pressure (PAP) therapy on PH in patients admitted for ADHF with OSA.\n\n\nMETHODS\nA two center randomized control trial comparing standard of care(SOC) therapy for ADHF versus addition of PAP therapy in patients with concomitant OSA.\n\n\nRESULTS\nTwenty-one consecutive patients were enrolled with 1:1 randomization to SOC versus SOC plus 48 hour PAP therapy protocol.In the intervention arm the mean pulmonary artery systolic pressure (PASP) difference before therapy and after 48 hours of PAP therapy was -15.8 ± 3.2 (58.6 ± 2.5 mmHg to 42.8 ± 2.7 ) versus the SOC arm where the mean PASP difference was -5.2 ± 2.6 ( 62.7 ± 3.3 mmHg reduced to 57.5 ± 3.9) ( p=0.025). In addition ejection fraction (EF) in the intervention arm improved (3.4 ± 1.5 % versus -0.5 ± 0.5 %) (p=0.01). Significant improvement was also noted in tricuspid annular plane systolic excursion (TAPSE) and right ventricular (RV) systolic area in the intervention arm but not in NT pro BNP or six minute walk distance.\n\n\nCONCLUSIONS\nIn patients with ADHF and OSA, addition of 48hrs of PAP-therapy to SOC treatment significantly reduced PH. In addition, PAP-therapy was able to improve right and left ventricular function.