Acute haemodynamic effects of continuous positive airway pressure in awake patients with heart failure

Background and objective Continuous positive airway pressure ( CPAP ) has been used to treat patients with chronic heart failure ( CHF ) and sleep‐disordered breathing ( SDB ). CPAP treatment in severe CHF with concomitant SDB and atrial fibrillation has been linked to impairment of cardiac output ( CO ) as a potential cause for adverse outcome. The aim of the present study was to test whether incremental CPAP application in awake CHF patients with SDB , with and without atrial fibrillation, induces acute alterations of blood pressure ( BP ), heart rate ( HR ) and CO . Methods During daytime, we applied incremental CPAP (4–10 cm H 2 O ) in 37 stable patients with CHF and SDB . BP and HR were assessed after each 1 cm H 2 O CPAP increase in 5‐min intervals in the entire sample, and CO was assessed at one centre ( n  = 11). Results Neither mean BP , HR nor CO changed significantly with incremental CPAP (at 0 and 10 cm H 2 O : 85 ± 2 and 84 ± 2 mm  H g, P  = 1.0, 63 ± 1 to 61 ± 2 b.p.m., P  = 0.88 and 2.03 ± 0.5 and 2.35 ± 0.8 L/min/m 2 , P  = 0.92, respectively). No significant differences in maximum BP drop or HR drop between patients with sinus rhythm and atrial fibrillation were found. In 1 of 37 patients, a prespecified event of haemodynamic compromise (drop of mean BP >15 mm Hg) without clinical signs occurred. Conclusions These results contribute to the evidence that CPAP does not cause haemodynamic compromise in the vast majority of normotensive CHF patients with SDB .