Adaptive servo-ventilation therapy of central sleep apnoea and its effect on sleep quality.
OBJECTIVE
Poor sleep quality is common in patients with chronic heart failure (CHF). This study tested the hypothesis that adaptive servo-ventilation (ASV) therapy in CHF patients whose central sleep apnoea (CSA) was not suppressed by continuous positive airway pressure (CPAP) (CPAP-non-responders) would improve sleep quality compared to CPAP-responders receiving ongoing CPAP therapy.


METHODS
Eighty-two patients with CHF (65 ± 9 years, left ventricular ejection fraction 35 ± 16 %) and CSA [apnoea-hypopnoea index (AHI) ≥15/h] were retrospectively studied. Within an average of 47 days, patients were reevaluated on CPAP therapy and stratified according to their suppression of CSA: 34 were CPAP-non-responders switched to ASV therapy the following day and 48 were CPAP-responders who continued on CPAP therapy. Polysomnographic parameters were assessed in the diagnostic night and on the last night of PAP therapy (CPAP or ASV) before the patient was discharged with the final pressure settings.


RESULTS
Compared with the CPAP group, the ASV group had significantly greater reductions from baseline in AHI (-37 ± 15/h vs -28 ± 18/h, p = 0.02), arousal index (-12.7 ± 13.6/h vs -6.8 ± 12.5/h, p = 0.04) and sleep stage N1 (-9 ± 14 % vs -2 ± 12 %, p = 0.03). In addition, the ASV group gained significantly more rapid eye movement (REM) sleep compared with the CPAP group (+5 ± 9 % vs +1 ± 9 %, p = 0.02).


CONCLUSIONS
CPAP therapy is effective in reducing AHI in a significant proportion of CHF patients with reduced ejection fraction and CSA. Treatment of CSA with ASV in CHF patients reduces sleep fragmentation and improves sleep structure to a significantly greater extent than changes seen in responders to CPAP therapy.
Department of Internal Medicine II, Cardiology and Pneumology, Centre for Sleep Medicine, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany.
Andrea
A
Hetzenecker
Department of Internal Medicine II, Cardiology and Pneumology, Centre for Sleep Medicine, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany.
Tatjana
T
Roth
Department of Internal Medicine II, Cardiology and Pneumology, Centre for Sleep Medicine, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany.
Christoph
C
Birner
Department of Internal Medicine II, Cardiology and Pneumology, Centre for Sleep Medicine, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany.
Lars S
LS
Maier
Department of Internal Medicine II, Cardiology and Pneumology, Centre for Sleep Medicine, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany.|Department of Pneumology, Donaustauf Hospital, Donaustauf, Germany.|Clinic for Pulmonology, Hospital of the Order of St. John of God Regensburg, Regensburg, Germany.
Michael
M
Pfeifer
Department of Internal Medicine II, Cardiology and Pneumology, Centre for Sleep Medicine, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany. michael.arzt@ukr.de.
Michael
M
Arzt
D000368:Aged; D002908:Chronic Disease; D045422:Continuous Positive Airway Pressure; D005260:Female; D006333:Heart Failure / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012119:Respiration; D012121:Respiration, Artificial / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors; D012890:Sleep; D020182:Sleep Apnea, Central / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D012893:Sleep Wake Disorders / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left
Heart failure; Positive pressure ventilation; Sleep apnoea; Sleep quality