Adaptive servoventilation improves cardiac function in patients with chronic heart failure and Cheyne-Stokes respiration.
OBJECTIVE
Sleep disordered breathing (SDB), especially Cheyne-Stokes respiration (CSR) is common in patients with chronic heart failure (CHF). Adaptive servoventilation (ASV) was recently introduced to treat CSR in CHF. The aim of this study was to investigate the effects of ASV on CSR and CHF parameters.


METHODS
In 29 male patients (63.9+/-9 years, NYHA> or =II, left ventricular ejection fraction [LV-EF]< or =40%), cardiorespiratory polygraphy, cardiopulmonary exercise (CPX) testing, and echocardiography were performed and concentrations of NT-proBNP determined before and after 5.8+/-3.5 months (median 5.7 months) of ASV (AutoSet CS2, ResMed) treatment. All patients also received guideline-driven CHF therapy.


RESULTS
Apnoea-hypopnoea-index was reduced from 37.4+/-9.4/h to 3.9+/-4.1/h (p<0.001). Workload during CPX testing increased from 81+/-26 to 100+/-31 W (p=0.005), oxygen uptake (VO2) at the anaerobic threshold from 12.6+/-3 to 15.3+/-4 ml/kg/min (p=0.01) and predicted peak VO2 from 58+/-12% to 69+/-17% (p=0.007). LV-EF increased from 28.2+/-7% to 35.2+/-11% (p=0.001), and NT-proBNP levels decreased significantly (2285+/-2192 pg/ml to 1061+/-1293 pg/ml, p=0.01).


CONCLUSIONS
In selected patients with CHF and CSR, addition of ASV to standard heart failure therapy is able to improve SDB, CPX test results, LV-EF and NT-proBNP concentrations.
Oldenburg
Olaf
O
Department of Cardiology, Heart and Diabetes Centre North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany. akohlstaedt@hdz-nrw.de <akohlstaedt@hdz-nrw.de>
Schmidt
Anke
A
Lamp
Barbara
B
Bitter
Thomas
T
Muntean
Bogdan G
BG
Langer
Christoph
C
Horstkotte
Dieter
D
D000368:Aged; D002639:Cheyne-Stokes Respiration / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D015331:Cohort Studies; D017079:Exercise Tolerance / Q000502:physiology; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000503:physiopathology* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D011175:Positive-Pressure Respiration / Q000379:methods*; D012042:Registries; D012189:Retrospective Studies; D012891:Sleep Apnea Syndromes / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D013318:Stroke Volume / Q000502:physiology
D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain