title: Treatment of sleep apnea in chronic heart failure patients with auto-servo ventilation improves sleep fragmentation: a randomized controlled trial.
abstract: BACKGROUND
  Impaired sleep efficiency is independently associated with worse prognosis in patients with chronic heart failure (CHF). Therefore, a test was conducted on whether auto-servo ventilation (ASV, biphasic positive airway pressure [BiPAP]-ASV, Philips Respironics) reduces sleep fragmentation and improves sleep efficiency in CHF patients with central sleep apnea (CSA) or obstructive sleep apnea (OSA).
  
  
  METHODS
  In this multicenter, randomized, parallel group trial, a study was conducted on 63 CHF patients (age 64 ± 10 years; left ventricular ejection fraction 29 ± 7%) with CSA or OSA (apnea-hypopnea Index, AHI 47 ± 18/h; 46% CSA) referred to sleep laboratories of the four participating centers. Participants were randomized to either ASV (n = 32) or optimal medical treatment alone (control, n = 31).
  
  
  RESULTS
  Polysomnography (PSG) and actigraphy at home (home) with centralized blinded scoring were obtained at baseline and 12 weeks. ASV significantly reduced sleep fragmentation (total arousal indexPSG: -16.4 ± 20.6 vs. -0.6 ± 13.2/h, p = 0.001; sleep fragmentation indexhome: -7.6 ± 15.6 versus 4.3 ± 13.9/h, p = 0.003, respectively) and significantly increased sleep efficiency assessed by actigraphy (SEhome) compared to controls (2.3 ± 10.1 vs. -2.1 ± 6.9%, p = 0.002). Effects of ASV on sleep fragmentation and efficiency were similar in patients suffering from OSA and CSA.
  
  
  CONCLUSIONS
  At home, ASV treatment modestly improves sleep fragmentation as well as sleep efficiency in CHF patients having either CSA or OSA.
authors: Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany; Center for Pneumology, Donaustauf Hospital, Donaustauf, Germany.
authors: Andrea
authors: A
authors: Hetzenecker
authors: Centre de Médecine du Sommeil, Hopital Antoine Beclere, Clamart, France.
authors: Pierre
authors: P
authors: Escourrou
authors: Department of Medicine, Perleman School of Medicine, University of Pennsylvania, USA; Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, USA.
authors: Samuel T
authors: ST
authors: Kuna
authors: Centre de Recherche, IUCPQ, Universite Laval, Quebec, Canada.
authors: Frederic
authors: F
authors: Series
authors: Department of Respiratory Medicine, Prince Philip Hospital and Swansea College of Medicine, Wales, UK.
authors: Keir
authors: K
authors: Lewis
authors: Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany.
authors: Christoph
authors: C
authors: Birner
authors: Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany; Center for Pneumology, Donaustauf Hospital, Donaustauf, Germany; Clinic for Pulmonology, Hospital of the Order of St. John of God Regensburg, Germany.
authors: Michael
authors: M
authors: Pfeifer
authors: Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany. Electronic address: michael.arzt@ukr.de.
authors: Michael
authors: M
authors: Arzt
mesh_terms: D000368:Aged; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000503:physiopathology*; D006801:Humans; D007385:Intermittent Positive-Pressure Ventilation / Q000379:methods; D008297:Male; D008875:Middle Aged; D017286:Polysomnography; D012891:Sleep Apnea Syndromes / Q000150:complications / Q000628:therapy*; D012892:Sleep Deprivation / Q000628:therapy*
keywords: Auto-servo ventilation; Heart failure; NT-pro BNP; Sleep disordered breathing; Sleep quality