Effect of oxygen versus adaptive pressure support servo-ventilation in patients with central sleep apnoea-Cheyne Stokes respiration and congestive heart failure.
OBJECTIVE
Central sleep apnoea with Cheyne-Stokes respiration (CSA-CSR) is a common, serious consequence of congestive heart failure. Optimal treatment is yet to be established. We compared two common treatments for CSA-CSR.


METHODS
Subjects with CSA-CSR and stable congestive heart failure were randomised to 8 weeks treatment: oxygen 2 L/min through nasal prongs and concentrator or 8 weeks adaptive servo-ventilation (ASV) using a crossover design separated by a 3-week washout. Polysomnography, indices of sleep and breathing, shuttle walk distance, symptoms, urinary catecholamines, plasma brain natriuretic peptide (NT-BNP) and echocardiography were collected at baseline and completion of each arm.


RESULTS
Ten subjects (age 64 ± 10 years, left ventricular ejection fraction (LVEF) 28 ± 10.5%, apnoea-hypopnoea index (AHI) 63 ± 30/h) were recruited. Seven completed the protocol (one died, one refused ASV, one was withdrawn after hospital admission). On therapy, an AHI of < 10/h was achieved in two out of seven using oxygen (29%), six of seven using ASV (86%) and six of seven with either (86%). Compliance with ASV: 5.2 ± 2 h/night (range 1.45-7.1 h/night). Median AHI on oxygen therapy: 13.4 /h (range 2.6-42.9/h), ASV, 1.4 /h (range 0.6-17.8/h, P = 0.03). LVEF was not changed by either therapy (oxygen 30.9% vs 30.9% P = 0.97, ASV 32.5% vs 35.0% P = 0.24). NT-BNP, urinary catecholamines, shuttle walk distance and symptoms were not significantly changed by either therapy.


CONCLUSIONS
CSA-CSR is reduced to a greater extent by ASV than oxygen therapy over 8 weeks but was not accepted long term. Neither treatment improved prognostic indices of heart failure or symptoms in the short term.
Department of Medicine, Otago University Wellington, Wellington, New Zealand. wellsleep@paradise.net.nz
A J
AJ
Campbell
K
K
Ferrier
A M
AM
Neill
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002639:Cheyne-Stokes Respiration / Q000453:epidemiology / Q000378:metabolism / Q000628:therapy*; D015331:Cohort Studies; D018592:Cross-Over Studies; D005260:Female; D006333:Heart Failure / Q000453:epidemiology / Q000378:metabolism / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010102:Oxygen Inhalation Therapy / Q000379:methods*; D020182:Sleep Apnea, Central / Q000453:epidemiology / Q000378:metabolism / Q000628:therapy*; D016896:Treatment Outcome; D055815:Young Adult