title: A randomized controlled trial of adaptive ventilation for Cheyne-Stokes breathing in heart failure.
abstract: Heart failure is associated with Cheyne-Stokes breathing, which fragments patients' sleep. Correction of respiratory disturbance may reduce sleep fragmentation and excessive daytime sleepiness. This randomized prospective parallel trial assesses whether nocturnal-assist servoventilation improves daytime sleepiness compared with the control. A total of 30 subjects (29 male) with Cheyne-Stokes breathing (mean apnea-hypopnea index 19.8 [SD 2.6] and stable symptomatic chronic heart failure (New York Heart Association Class II-IV) were treated with 1 month's therapeutic (n = 15) or subtherapeutic adaptive servoventilation. Daytime sleepiness (Osler test) was measured before and after the trial with change in measured sleepiness the primary endpoint. Secondary endpoints included brain natriuretic peptide levels and catecholamine excretion. Active treatment reduced excessive daytime sleepiness; the mean Osler change was +7.9 minutes (SEM 2.9), when compared with the control, the change was -1.0 minutes (SEM, 1.7), and the difference was 8.9 minutes (95% confidence interval, 1.9-15.9 minutes; p = 0.014, unpaired t test). Significant falls occurred in plasma brain natriuretic peptide and urinary metadrenaline excretion. We conclude that adaptive servoventilation produces an improvement in excessive daytime sleepiness in patients with Cheyne-Stokes breathing and chronic heart failure. This study suggests improvements in neurohormonal activation with this treatment.
authors.affiliation: Oxford Sleep Unit, Oxford Centre for Respiratory Medicine, Oxford Radcliffe Hospital, Oxford, United Kingdom. justinpepperell@doctors.org.uk
authors.forename: Justin C T
authors.initials: JC
authors.lastname: Pepperell
authors.forename: Nick A
authors.initials: NA
authors.lastname: Maskell
authors.forename: David R
authors.initials: DR
authors.lastname: Jones
authors.forename: Beverley A
authors.initials: BA
authors.lastname: Langford-Wiley
authors.forename: Nicky
authors.initials: N
authors.lastname: Crosthwaite
authors.forename: John R
authors.initials: JR
authors.lastname: Stradling
authors.forename: Robert J O
authors.initials: RJ
authors.lastname: Davies
mesh_terms: D000368:Aged; D002245:Carbon Dioxide / Q000097:blood; D002395:Catecholamines / Q000652:urine; D002639:Cheyne-Stokes Respiration / Q000209:etiology* / Q000628:therapy*; D006970:Disorders of Excessive Somnolence / Q000209:etiology / Q000628:therapy; D004311:Double-Blind Method; D005260:Female; D006304:Health Status; D006333:Heart Failure / Q000097:blood / Q000150:complications* / Q000652:urine; D006801:Humans; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood; D017286:Polysomnography; D011175:Positive-Pressure Respiration; D011446:Prospective Studies; D020182:Sleep Apnea, Central / Q000209:etiology / Q000628:therapy; D011795:Surveys and Questionnaires
chemical_list: D002395:Catecholamines; D020097:Natriuretic Peptide, Brain; D002245:Carbon Dioxide