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Effects of continuous positive airway pressure treatment on coronary vasoreactivity measured by 82Rb cardiac PET/CT in obstructive sleep apnea patients

  • Sleep Breathing Physiology and Disorders • Original Article
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Abstract

Purpose

Obstructive sleep apnea syndrome (OSA) increases the risk of cardiovascular disease. We aimed at evaluating the effect of continuous positive airway pressure (CPAP) treatment on coronary endothelium-dependent vasoreactivity in OSA patients by quantifying myocardial blood flow (MBF) response to cold pressure testing (CPT).

Methods

In the morning after polysomnography (PSG), all participants underwent a dynamic 82Rb cardiac positron emitting tomography/computed tomography (PET/CT) scan at rest, during CPT and adenosine stress. PSG and PET/CT were repeated at least 6 weeks after initiating CPAP treatment. OSA patients were compared to controls and according to response to CPAP. Patients’ characteristics and PSG parameters were used to determine predictors of CPT-MBF.

Results

Thirty-two untreated OSA patients (age 58 ± 13 years, 27 men) and 9 controls (age 62 ± 5 years, 4 men) were enrolled. At baseline, compared to controls (apnea-hypopnea index (AHI) = 5.3 ± 2.6/h), untreated OSA patients (AHI = 48.6 ± 19.7/h) tend to have a lower CPT-MBF (1.1 ± 0.2 mL/min/g vs. 1.3 ± 0.4 mL/min/g, p = 0.09). After initiating CPAP, CPT-MBF was not different between well-treated patients (AHI <10/h) and controls (1.3 ± 0.3 mL/min/g vs. 1.3 ± 0.4 mL/min/g, p = 0.83), but it was lower for insufficiently treated patients (AHI ≥10/h) (0.9 ± 0.2 mL/min/g vs. 1.3 ± 0.4 mL/min/g, p = 0.0045). CPT-MBF was also higher in well-treated than in insufficiently treated patients (1.3 ± 0.3 mL/min/g vs. 0.9 ± 0.2 mL/min/g, p = 0.001). Mean nocturnal oxygen saturation (β = −0.55, p = 0.02) and BMI (β = −0.58, p = 0.02) were independent predictors of CPT-MBF in OSA patients.

Conclusions

Coronary endothelial vasoreactivity is impaired in insufficiently treated OSA patients compared to well-treated patients and controls, confirming the need for CPAP optimization.

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Author notes

    Authors and Affiliations

    1. Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, Rue du Bugnon 46, 1011, Lausanne, Switzerland

      Vincent Dunet, Gilles Allenbach & John O. Prior

    2. Department of Radiology, Lausanne University Hospital, Lausanne, Switzerland

      Vincent Dunet

    3. Center for Investigation and Research in Sleep (CIRS), Department of Pneumology, Lausanne University Hospital, Lausanne, Switzerland

      Vincianne Rey-Bataillard, Nicolas Beysard, Alban Lovis & Raphael Heinzer

    Authors
    1. Vincent Dunet
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    2. Vincianne Rey-Bataillard
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    3. Gilles Allenbach
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    5. Alban Lovis
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    6. John O. Prior
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    Correspondence to John O. Prior.

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    Conflict of interest

    RH acts in the advisory board of the Night Balance company. All other authors declare that they have no competing interests.

    Funding

    This work was supported by research grants from the Swiss National Science Foundation (Grant #320000-109986), the Michel Tossizza Foundation (Lausanne, Switzerland), and the Société Académique Vaudoise (Lausanne, Switzerland). JOP was supported by an Academic Research Award from the Leenaards Foundation (Lausanne, Switzerland).

    Ethical approval

    All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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    Informed consent was obtained from all individual participants included in the study.

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    John O. Prior and Raphael Heinzer contributed equally to this work.

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    Dunet, V., Rey-Bataillard, V., Allenbach, G. et al. Effects of continuous positive airway pressure treatment on coronary vasoreactivity measured by 82Rb cardiac PET/CT in obstructive sleep apnea patients. Sleep Breath 20, 673–679 (2016). https://doi.org/10.1007/s11325-015-1272-1

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    • DOI: https://doi.org/10.1007/s11325-015-1272-1

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