Adaptive servo‐ventilation therapy improves cardiac sympathetic nerve activity in patients with heart failure

Abstract

AimsThis study investigated whether abnormal cardiac sympathetic nerve activity (SNA) is associated with the severity of central sleep apnoea (CSA) and whether adaptive servo-ventilation (ASV) therapy can improve cardiac SNA in heart failure (HF) patients with predominant CSA. Methods and resultsOvernight polysomnography was conducted to diagnose CSA. Cardiac SNA was analysed by [ 123 I]metaiodobenzylguanidine scintigraphy in 26 consecutive HF patients with predominant CSA. Of the 26 patients, 10 agreed to ASV therapy. Cardiac SNA was analysed 6 months after initiating ASV based on a non-randomized protocol. The apnoeahypopnoea index and central apnoea index were significantly correlated with the washout rate (WR) and a delayed heart to mediastinal (H/M) ratio, suggesting that SNA is associated with abnormal breathing patterns. The WR, H/M ratio, plasma BNP level, and LVEF were significantly improved (WR, 40.0 + 11.6% vs. 34.6 + 11.4%, P ¼ 0.046; H/M ratio, 1.5 + 0.1 vs.1.8 + 0.3, P ¼ 0.013; ln BNP, 5.4 + 1.0 vs. 4.6 + 1.2, P ¼ 0.007; and LVEF, 43.8 + 10.4% vs. 47.0 + 10.6%, P , 0.001) in the ASV group patients, but not in the non-ASV group patients. Multiple linear regression analyses showed that a decreased WR was strongly associated with an increased LVEF (coefficient ¼ -0.454, P ¼ 0.013). ConclusionsAbnormal cardiac SNA could be significantly correlated with the severity of CSA in HF patients. ASV therapy might improve cardiac function in these patients by partially mediating cardiac SNA regulation.--

Effective Treatment of Congestive Heart Failure Using Adaptive Servo-ventilation in an End-stage Renal Disease Patient on Hemodialysis

“…Previous studies have indicated that ASV reduces an enhanced sympathetic nerve activity (7,8). However, the present patient experienced no significant changes in heart rate or systemic vascular resistance while under ASV therapy.…”

Effects of Short-Term Continuous Positive Airway Pressure on Myocardial Sympathetic Nerve Function and Energetics in Patients With Heart Failure and Obstructive Sleep Apnea

“…24,25 A recent nonrandomized study suggested that adaptive servoventilation improved cardiac SN function measured with the use of 123 I-metaiodobenzylguanidine in 10 patients with central sleep apnea and HF. 45 To our knowledge, however, the present study is the first to evaluate the effects of CPAP therapy on myocardial SN function with a randomized design, quantified with the use of Data are mean±SD or n (%). ACEi indicates angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor blocker; CAD, coronary artery disease; CPAP, continuous positive airway pressure; HF, heart failure; K mono , monoexponential function fit to the myocardial 11 C-acetate time-activity data; LV, left ventricular; NYHA, New York Heart Association; and WMI, work metabolic index.…”

Right Ventricular End-Diastolic Pressure Is a Key to the Changes in Cardiac Output During Adaptive Servo-Ventilation Support in Patients With Heart Failure

“…This treatment was originally developed to treat sleep-disordered breathing (SDB), but has been widely indicated for the treatment of moderate to advanced heart failure (HF) even in the absence of SDB. [2][3][4][5][6][7][8][9][10][11][12][13][14] Cowie, et al recently demonstrated an increased mortality in patients receiving aggressive ASV therapy for HF and central sleep apnea compared with the control group. 15) Another Japanese prospective randomized controlled study did not show an obvious advantage of ASV therapy over optimal medical therapy.…”