Acute effects of different levels of continuous positive airway pressure on cardiac autonomic modulation in chronic heart failure and chronic obstructive pulmonary disease

Abstract

IntroductionNon-invasive ventilation may improve autonomic modulation and ventilatory parameters in severely disabled patients. The aim of the present study was to evaluate the physiological influence of acute treatment with different levels of continuous positive airway pressure (CPAP) on the autonomic balance of heart and respiratory responses in patients with stable chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF).Materials and methodsA COPD group (n = 10), CHF group (n = 8) and healthy subjects (n = 10) were evaluated. The participants were randomized to receive three different levels of CPAP on the same day: sham ventilation (Sham), 5 cmH20 (CPAP5) and 10 cmH20 (CPAP10) for 10 min. Respiratory rate, end tidal carbon dioxide (ETCO2), peripheral oxygen saturation (SpO2), heart rate (HR), blood pressure and heart rate variability in the time and frequency domains were measured during spontaneous breathing and under the sham, CPAP5 and CPAP10 conditions.ResultsAll groups experienced a reduction in ETCO2 values during treatment with CPAP (p < 0.05). CPAP increased SpO2 and HR in the COPD group (p < 0.05). The COPD group also had lower RMSSD values during treatment with different levels of CPAP when compared to the control group (p < 0.05). In the CHF group, CPAP5 and CPAP10 increased the SDNN value (p < 0.05). CPAP10 reduced the SDNN value in the COPD group (p < 0.05).ConclusionThe findings suggest that CPAP may cause improvements in the neural control of heart rate in patients with stable COPD and CHF. For each patient, the “best CPAP level” should be defined as the best respiratory response and autonomic balance.

Effect of respiratory rehabilitation techniques on the autonomic function in patients with chronic obstructive pulmonary disease: A systematic review

“…5,22,37,40 This result is also corroborated by the findings of an earlier study that reported that NIMV has opposing influence on the HRV. 46 Three studies also reported significant increases in the values of LF HRV indices.…”

“…Eight articles were further excluded for failure to meet all the inclusion criteria. In the end, 18 studies comprising eleven case-controlled, 6,8,10,15,22,[35][36][37][38][39]41 four cohort, 5,19,27,40 and three RCT 20,23,28 studies were included for evidence synthesis.…”

“…6,28,41 Only three AF outcomes were reported in the included studies. Majority of the studies (14 of 18) reported on the HRV indices 5,6,19,20,22,23,27,28,35,[37][38][39][40]41 followed by the BRS 8,20,35,36 in four studies and then the MSNA in two studies. 10,15 Furthermore, the HRV parameters were represented in terms of time and frequency domain analyses.…”

“…Five studies 5,22,23,37,40 reported on the effect of NIMV application on the HRV indices in both time and frequency domain analyses in patients with COPD. Both significant and nonsignificant changes were reported in the results of the reviewed studies.…”

“…Both significant and nonsignificant changes were reported in the results of the reviewed studies. Specifically, the results across the studies showed that just as no significant changes occurred for RMSSD, 22,37 Based on the reviewed studies, the evidence to support the effect of NIMV application on the HRV indices is inconsistent.…”