title: Effects of dynamic bilevel positive airway pressure support on central sleep apnea in men with heart failure.
abstract: BACKGROUND
  Treatment with continuous positive airway pressure (CPAP) improves cardiac function in chronic heart failure (CHF) patients with central sleep apnea (CSA)-Cheyne-Stokes respiration (CSR) by stabilizing ventilation, but frequently central apneas and hypopneas persist. Our objective was to test the hypothesis that flow-targeted dynamic bilevel positive airway pressure (BPAP) support (BiPAP autoSV; Respironics; Murrysville, PA) effectively suppresses CSR-CSA in CHF patients.
  
  
  METHODS
  We studied 14 CHF patients with CSR-CSA (and residual CSA on positive airway pressure therapy) during 3 consecutive nights: (1) diagnostic polysomnography, (2) CPAP (n=10) or BPAP (n=4) titration, and (3) dynamic flow-targeted dynamic BPAP support with an expiratory positive airway pressure (EPAP) set to suppress obstructive respiratory events, and an inspiratory positive airway pressure (IPAP) dynamically ranging between 0 and 15 cm H2O above the EPAP.
  
  
  RESULTS
  CPAP or BPAP significantly reduced the apnea-hypopnea index (AHI) [mean+/-SD, 46+/-4 events/h to 22+/-4 events/h; p=0.001] compared to the first night without treatment. Flow-targeted dynamic BPAP support (mean EPAP, 6.5+/-1.7 cm H2O; maximal IPAP, 21.9+/-2.1 cm H2O) further reduced the AHI to 4+/-1/h of sleep compared to the untreated (p<0.001) and CPAP or BPAP night (p=0.002). After the first night of flow-targeted dynamic BPAP support, patients rated on an analog scale (range, 0 to 10) the treatment as comfortable (6.9+/-0.6), and the sleep quality as improved compared to previous nights (7.4+/-0.6).
  
  
  CONCLUSIONS
  Flow-targeted dynamic BPAP support effectively suppresses CSR-CSA in patients with CHF and is well tolerated.
authors.affiliation: Department of Internal Medicine II, University of Regensburg, Franz-Josef-Straubeta-Allee 11, 93042 Regensburg, Germany. michael.arzt@klinik.uni-regensburg.de
authors.forename: Michael
authors.initials: M
authors.lastname: Arzt
authors.forename: Roland
authors.initials: R
authors.lastname: Wensel
authors.forename: Sylvia
authors.initials: S
authors.lastname: Montalvan
authors.forename: Thomas
authors.initials: T
authors.lastname: Schichtl
authors.forename: Stephan
authors.initials: S
authors.lastname: Schroll
authors.forename: Stephan
authors.initials: S
authors.lastname: Budweiser
authors.forename: Friedrich C
authors.initials: FC
authors.lastname: Blumberg
authors.forename: Günther A J
authors.initials: GA
authors.lastname: Riegger
authors.forename: Michael
authors.initials: M
authors.lastname: Pfeifer
mesh_terms: D000368:Aged; D000465:Algorithms; D002639:Cheyne-Stokes Respiration / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy*; D045422:Continuous Positive Airway Pressure / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D006333:Heart Failure / Q000150:complications* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D017286:Polysomnography; D012123:Pulmonary Ventilation / Q000502:physiology; D020182:Sleep Apnea, Central / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy*; D016896:Treatment Outcome