title: Trilevel adaptive servoventilation for the treatment of central and mixed sleep apnea in chronic heart failure patients.
abstract: BACKGROUND
  Sleep-disordered breathing (SDB) in patients with heart failure (HF) is of major prognostic impact, though treatment of simultaneously occurring central and mixed apnea events is challenging. The objective was to examine long-term effects of a new trilevel adaptive servoventilation (ASV) therapy in patients with systolic or diastolic HF.
  
  
  METHODS
  A total of 45 consecutive patients with a history of HF, elevated N-terminal prohormone of brain natriuretic peptide levels, objective signs of cardiac dysfunction, and moderate to severe SDB (apnea-hypopnea index [AHI] > or =15/h) with combined central and mixed respiratory events were included in this study and ASV therapy (SOMNOvent CR, Weinmann) was offered.
  
  
  RESULTS
  In 38 patients (84%), ASV therapy was successfully initiated, with 23 (51%) patients showing appropriate compliance (device use > or = 4 h/night for > or = 5d/w) after 3.6±1.2 months. In these patients ASV therapy and HF status were re-evaluated. A sustained reduction was achieved in AHI (42.8±17.5/h vs 8.9±5.8/h; p<0.001) and oxygen saturation. Improvements also were recorded in New York Heart Association (NYHA) functional class (2.4±0.5-1.9±0.4; p<0.001) and oxygen uptake during cardiopulmonary exercise testing (VO2 peak, 13.64±3.5-15.8±5.8 ml/kg/min; p<0.002).
  
  
  CONCLUSIONS
  In selected HF patients, trilevel ASV therapy is able to treat SDB with combined central and mixed respiratory events. This treatment is associated with an improvement in HF symptoms and objective cardiopulmonary performance.
authors: Dept. of Cardiology, Heart and Diabetes Centre North Rhine Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany. akleemeyer@hdz-nrw.de
authors: Olaf
authors: O
authors: Oldenburg
authors: Thomas
authors: T
authors: Bitter
authors: Birgit
authors: B
authors: Wellmann
authors: Thomas
authors: T
authors: Fischbach
authors: Christina
authors: C
authors: Efken
authors: Anke
authors: A
authors: Schmidt
authors: Dieter
authors: D
authors: Horstkotte
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002639:Cheyne-Stokes Respiration / Q000150:complications / Q000628:therapy; D002908:Chronic Disease; D045422:Continuous Positive Airway Pressure / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D054144:Heart Failure, Diastolic / Q000150:complications*; D054143:Heart Failure, Systolic / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012891:Sleep Apnea Syndromes / Q000150:complications* / Q000628:therapy*; D016896:Treatment Outcome