Adaptive servo-ventilation in patients with coexisting obstructive sleep apnoea/hypopnoea and Cheyne-Stokes respiration.
OBJECTIVE
The coexistence of obstructive (OSAS) and central sleep apnoea (CSA) and Cheyne-Stokes respiration (CSR) is common in patients with and without underlying heart diseases. CPAP has been shown to improve CSA/CSR by about 50%, but recent data suggest maximal suppression of CSA is important in improving clinical outcomes in heart failure patients. Adaptive servo-ventilation (ASV) effectively suppresses CSA/CSR in heart failure, but only few trials have considered patients with coexisting OSAS and CSA/CSR.


METHODS
Prospective, observational pilot study to evaluate the efficacy of a new ASV device, the BiPAP AutoSV, in 10 male consecutive patients with coexisting OSAS and CSA/CSR with and without heart failure over eight weeks. Six had stable heart failure.


RESULTS
The total AHI improved from 48.9+/-20.6/h to 8.7+/-7.4, the obstructive AHI from 15.8+/-16.2/h to 2.6+/-2.5/h and the central AHI from 33.1+/-10.8/h to 6.1+/-5.9/h (all p<0.01). Furthermore, there was a significant improvement in sleep profile and respiratory related arousals. The six patients with cardiovascular disease, including three with congestive heart failure, showed similar improvements in all parameters.


CONCLUSIONS
BiPAP AutoSV was effective in reducing all types of respiratory disturbances in coexisting OSAS and CSA/CSR with and without heart failure. Further studies comparing the long-term clinical efficacy of this device against CPAP are warranted.
Randerath
Winfried J
WJ
Institute of Pneumology at the University Witten/Herdecke, Clinic for Pneumology and Allergology, Center of Sleep Medicine and Respiratory Care, Bethanien Hospital, Solingen, Germany. randerath@klinik-bethanien.de
Galetke
Wolfgang
W
Stieglitz
Sven
S
Laumanns
Cordula
C
Schäfer
Thorsten
T
D000222:Adaptation, Physiological; D000368:Aged; D002639:Cheyne-Stokes Respiration / Q000453:epidemiology* / Q000503:physiopathology*; D045422:Continuous Positive Airway Pressure / Q000379:methods*; D006333:Heart Failure / Q000453:epidemiology; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D017286:Polysomnography; D011446:Prospective Studies; D012123:Pulmonary Ventilation; D020182:Sleep Apnea, Central / Q000453:epidemiology* / Q000628:therapy*; D020181:Sleep Apnea, Obstructive / Q000453:epidemiology* / Q000628:therapy*