Background and aims: Sleep disordered breathing (SDB), especially Cheyne-Stokes respiration (CSR) is common in patients with chronic heart failure (CHF). Adaptive servoventilation (ASV) was recently introduced to treat CSR in CHF. The aim of this study was to investigate the effects of ASV on CSR and CHF parameters. Methods: In 29 male patients (63.9 ± 9 years, NYHA ≥ II, left ventricular ejection fraction [LV-EF] ≤ 40%), cardiorespiratory polygraphy, cardiopulmonary exercise (CPX) testing, and echocardiography were performed and concentrations of NT-proBNP determined before and after 5.8 ± 3.5 months (median 5.7 months) of ASV (AutoSet CS™2, ResMed) treatment. All patients also received guideline-driven CHF therapy. Results: Apnoea-hypopnoea-index was reduced from 37.4 ± 9.4/h to 3.9 ± 4.1/h (p b 0.001). Workload during CPX testing increased from 81 ± 26 to 100 ± 31 W (p = 0.005), oxygen uptake (VO 2 ) at the anaerobic threshold from 12.6 ± 3 to 15.3 ± 4 ml/kg/min (p = 0.01) and predicted peak VO 2 from 58 ± 12% to 69 ± 17% (p = 0.007). LV-EF increased from 28.2 ± 7% to 35.2 ± 11% (p = 0.001), and NT-proBNP levels decreased significantly (2285 ± 2192 pg/ml to 1061 ± 1293 pg/ml, p = 0.01). Conclusions: In selected patients with CHF and CSR, addition of ASV to standard heart failure therapy is able to improve SDB, CPX test results, LV-EF and NT-proBNP concentrations.

Cheyne–Stokes respiration (CSR) in patients with chronic heart failure (CHF) is of major prognostic impact and expresses respiratory instability. Other parameters are daytime pCO2, VE/VCO2-slope during exercise, exertional oscillatory ventilation (EOV), and increased sensitivity of central CO2 receptors. Adaptive servoventilation (ASV) was introduced to specifically treat CSR in CHF. Aim of this study was to investigate ASV effects on CSR, cardiac function, and respiratory stability. A total of 105 patients with CHF (NYHA ≥ II, left ventricular ejection fraction (EF) ≤ 40%) and CSR (apnoea–hypopnoea index ≥ 15/h) met inclusion criteria. According to adherence to ASV treatment (follow-up of 6.7 ± 3.2 months) this group was divided into controls (rejection of ASV treatment or usage <50% of nights possible and/or <4 h/night; n = 59) and ASV (n = 56) adhered patients. In the ASV group, ventilator therapy was able to effectively treat CSR. In contrast to controls, NYHA class, EF, oxygen uptake, 6-min walking distance, and NT-proBNP improved significantly. Moreover, exclusively in these patients pCO2, VE/VCO2-slope during exercise, EOV, and central CO2 receptor sensitivity improved. In CHF patients with CSR, ASV might be able to improve parameters of SDB, cardiac function, and respiratory stability.

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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.

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