Diuretics in obstructive sleep apnea with diastolic heart failure
| Autor: | Giovanni Rolla, Roberto Mutani, Alberto Battisti, Luisa Brussino, Alessandro Cicolin, C. Bucca, Mangiardi L |
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| Jazyk: | angličtina |
| Rok vydání: | 2007 |
| Předmět: |
Pulmonary and Respiratory Medicine
Adult Male Polysomnography Spironolactone Critical Care and Intensive Care Medicine Nitric Oxide acoustic pharyngometry exhaled nitric oxide inspiratory flows pharyngeal edema Diastole Furosemide Forced Expiratory Volume medicine Humans Diuretics Aged Heart Failure Sleep Apnea Obstructive Ejection fraction E/A ratio business.industry Diastolic heart failure Sleep apnea Stroke Volume Middle Aged medicine.disease Myocardial Contraction Echocardiography Doppler respiratory tract diseases Obstructive sleep apnea Treatment Outcome Apnea–hypopnea index Heart failure Anesthesia Injections Intravenous Drug Therapy Combination Female Blood Gas Analysis Cardiology and Cardiovascular Medicine business medicine.drug |
| Popis: | Upper airway edema might contribute to pharyngeal collapsibility and account for the high prevalence of obstructive sleep apnea (OSA) in patients with heart disease. The aim of this study was to evaluate if intensive unloading with diuretics improves sleep-disordered breathing and increases pharyngeal caliber in patients with severe OSA and diastolic heart failure.Fifteen patients with severe OSA, hypertension, and diastolic heart failure were hospitalized to receive IV furosemide, 20 mg, and spironolactone, 100 mg, bid for 3 days. Polysomnography was performed for assessment of apnea-hypopnea index (AHI), acoustic pharyngometry was performed for assessment of the oropharyngeal junction (OPJ) area, and forced midinspiratory flow (FIF(50)), forced midexpiratory flow (FEF(50))/FIF(50) percentage, and exhaled nitric oxide (FeNO) were measured before and after diuretic treatment.Diuretic treatment produced a significant decrease in body weight, BP, and AHI (from 74.89 +/- 6.95 to 57.17 +/- 5.40/h, p0.001), associated with an improvement in OPJ area (from 1.33 +/- 0.10 to 1.78 +/- 0.16 cm(2), p = 0.007), FIF(50) (from 3.16 +/- 0.4 to 3.94 +/- 0.4 L/s, p = 0.006), and FEF(50)/FIF(50) percentage (from 117.9 +/- 11.8 to 93.15 +/- 10.1%, p = 0.002). Weight loss was significantly related to the decrease of AHI (R = 0.602; p = 0.018), to the increase of FIF(50) (R = 0.68; p = 0.005), and to the decrease of FEF(50)/FIF(50) (R = 0.635; p = 0.011).These findings suggest that pharyngeal edema contributes to sleep-disordered breathing in obese patients with severe OSA, hypertension, and diastolic heart failure. Upper airway edema may contribute to the frequent occurrence of OSA in patients with heart disease. |
| Databáze: | OpenAIRE |
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