Adaptive servo-ventilation in heart failure patients with sleep apnea: A real world study

Hastings, Peter C.; Vazir, Ali; Meadows, Guy E.; Dayer, Mark; Poole‐Wilson, Philip A.; Morrell, Mary J.; Cowie, Martin R.; Simonds, Anita K.

doi:10.1016/j.ijcard.2008.08.022

Cited by 95 publications

(69 citation statements)

References 27 publications

(35 reference statements)

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“…It has also been reported that hydrogen protects cells and tissues against oxidative stress by scavenging hydroxyl radicals (22) and might prevent a decrease of cellular ATP levels (23). Since we found that IH aggravated underlying abnormalities and reduced systolic function, one of the mechanisms through which adaptive servo-ventilation improves congestive HF might be alleviation of oxidative stress (11). We previously evaluated the effect of hydrogen gas inhalation on LV remodeling and dyslipidemia in mice when hydrogen was inhaled during reoxygenation, during hypoxia, or throughout the experimental period (13), and we showed that inhalation during hypoxia reduced oxidative stress and improved systolic dysfunction in the failing heart.…”

Section: Discussionmentioning

confidence: 99%

Hydrogen gas attenuates embryonic gene expression and prevents left ventricular remodeling induced by intermittent hypoxia in cardiomyopathic hamsters

Kato

Nomura

Sakamoto

et al. 2014

American Journal of Physiology-Heart and Circulatory Physiology

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T. Hydrogen gas attenuates embryonic gene expression and prevents left ventricular remodeling induced by intermittent hypoxia in cardiomyopathic hamsters. Am J Physiol Heart Circ Physiol 307: H1626 -H1633, 2014. First published October 3, 2014; doi:10.1152/ajpheart.00228.2014.-The prevalence of sleep apnea is very high in patients with heart failure (HF). The aims of this study were to investigate the influence of intermittent hypoxia (IH) on the failing heart and to evaluate the antioxidant effect of hydrogen gas. Normal male Syrian hamsters (n ϭ 22) and cardiomyopathic (CM) hamsters (n ϭ 33) were exposed to IH (repeated cycles of 1.5 min of 5% oxygen and 5 min of 21% oxygen for 8 h during the daytime) or normoxia for 14 days. Hydrogen gas (3.05 vol/100 vol) was inhaled by some CM hamsters during hypoxia. IH increased the ratio of early diastolic mitral inflow velocity to mitral annulus velocity (E/e=, 21.8 vs. 16.9) but did not affect the LV ejection fraction (EF) in normal Syrian hamsters. However, IH increased E/e= (29.4 vs. 21.5) and significantly decreased the EF (37.2 vs. 47.2%) in CM hamsters. IH also increased the cardiomyocyte cross-sectional area (672 vs. 443 m 2 ) and interstitial fibrosis (29.9 vs. 9.6%), along with elevation of oxidative stress and superoxide production in the left ventricular (LV) myocardium. Furthermore, IH significantly increased the expression of brain natriuretic peptide, ␤-myosin heavy chain, c-fos, and c-jun mRNA in CM hamsters. Hydrogen gas inhalation significantly decreased both oxidative stress and embryonic gene expression, thus preserving cardiac function in CM hamsters. In conclusion, IH accelerated LV remodeling in CM hamsters, at least partly by increasing oxidative stress in the failing heart. These findings might explain the poor prognosis of patients with HF and sleep apnea. heart failure; intermittent hypoxia; oxidative stress; cardiomyopathic hamster; hydrogen gas SLEEP APNEA SYNDROME (SAS) is a breathing disorder characterized by recurrent episodes of apnea and/or hypopnea that increases the risk of cardiovascular morbidity and mortality (10,19,26). In persons with SAS, recurrent hypopnea/apnea leads to intermittent hypoxia (IH). The prevalence of SAS is much higher in patients with established cardiovascular disease, and central sleep apnea is associated with the more severe forms of heart failure (17), although the mechanisms underlying periodic breathing in patients with heart failure (HF) are complex and multifactorial.Oxidative stress arises because of an imbalance between free radical production and endogenous antioxidant defenses and is increased in patients with HF (4). Free radicals have also been linked to endothelial dysfunction and increased sympathetic tone (2, 16), whereas intravenous infusion of antioxidants reduces free radical levels and attenuates sympathetic activity in animal models of HF (32). It has been suggested that hydrogen gas produced in the large intestine by intestinal bacteria might scavenge hydroxyl radicals (6), and it was recen...

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Section: Discussionmentioning

confidence: 99%

Hydrogen gas attenuates embryonic gene expression and prevents left ventricular remodeling induced by intermittent hypoxia in cardiomyopathic hamsters

Kato

Nomura

Sakamoto

et al. 2014

American Journal of Physiology-Heart and Circulatory Physiology

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“…In HF patients, CPAP mainly elevates intrathoracic pressure which reduces the venous return and preload, but CPAP therapy does not treat CSR directly. CPAP nonresponders should upgrade to ASV therapy, which effectively treats coexisting CSA and CSR in HF patients as well as other types of SDB, including OSA and complex sleep apnea syndrome, because ASV therapy provides suitable ventilator support using expiratory positive airway pressure and a pressure support system (Alam et al, 2007) (Khayat et al, 2010) (Hastings et al, 2010). However, prognosis was not improved for all patients after ASV therapy.…”

Section: Discussionmentioning

confidence: 99%

Improvement of Oxygen Saturation Levels is Associated with Response to Adaptive Servo-Ventilation Therapy in Heart Failure Patients

Kato¹,

Takama²,

Kurabayashi³

2014

JMED

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Although adaptive servo-ventilation (ASV) therapy is considered clinically beneficial to patients with heart failure (HF), a large proportion of patients fail to show improvement in HF. We aimed to identify reliable markers indicative of a favorable response to ASV.We evaluated 103 consecutive patients with New York Heart Association (NYHA) class II-IV HF who were scheduled for ASV therapy for 3 months. Patients were classified as responders if their brain natriuretic peptide levels were decreased after 3 months.Twenty-one patients (20.3%) failed to respond to ASV. No significant differences were observed between responders and nonresponders with regard to NYHA classification, age, gender, body mass index, drug therapy, and cardiovascular risk factors. Polysomnography showed no significant baseline differences between the 2 groups in the apnea-hypopnea index (AHI) and percent sleep time of oxygen saturation level below 90% (responders, 4.7% ± 9.2%; nonresponders, 3.7% ± 6.0%; P=0.68). The percent sleep time of oxygen saturation level below 90% is similar parameter as cumulative percentage of time at a pulse-oximetry oxygen saturation below 90% (CT90%) which is measured by in-home screening. We named it "Modified CT90%". After ASV therapy for 3 months, NYHA classification remarkably improved in responder group. Logistic regression analysis revealed that improvement of modified CT90%<1 was independent factor for the responder group. The adjusted odds ratio was 0.685 (95% confident interval 0.485 -0.967, P=0.03).Our study suggests that improvement of modified CT90%<1 at 3 months is associated with a favorable response to ASV therapy.

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“…When breathing resumes and ventilation exceeds the target, pressure support is reduced to the minimum of 3 cm H 2 O. Adaptive servo ventilation has been used primarily in the treatment of patients with sleep-disordered breathing associated with chronic congestive heart failure and Cheyne-Stokes respirations or periodic breathing. [62][63][64][65][66][67][68][69][70][71][72][73] Whether it might also have application during NIV in patients with acute respiratory failure has not been studied, to my knowledge.…”

Section: Mode Asynchronymentioning

confidence: 99%

Patient-Ventilator Interaction During Noninvasive Ventilation

Hess

2011

Respir Care

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There is arguably more evidence to support the use of noninvasive ventilation (NIV) than any other practice related to the care of patients with acute respiratory failure. Despite this strong evidence base, NIV seems to be under-utilized and the failure rate (need for intubation) may be as high as 40%. Some of these failures potentially relate to asynchrony, although the relationship between asynchrony and NIV failure has not been well studied. Good NIV tolerance has been associated with success of NIV, and improved comfort has been associated with better synchrony. In one study a high rate of asynchrony occurred in 43% of patients during NIV. Asynchrony is commonly associated with leaks. Thus, reducing the leak related to the interface and using a ventilator with good leak compensation should reduce the rate of asynchrony. Asynchronies can also be related to the underlying disease process. This paper reviews issues related to asynchrony during NIV and suggests strategies that might be used to correct asynchrony when it occurs.

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Adaptive servo-ventilation in heart failure patients with sleep apnea: A real world study

Cited by 95 publications

References 27 publications

Hydrogen gas attenuates embryonic gene expression and prevents left ventricular remodeling induced by intermittent hypoxia in cardiomyopathic hamsters

Hydrogen gas attenuates embryonic gene expression and prevents left ventricular remodeling induced by intermittent hypoxia in cardiomyopathic hamsters

Improvement of Oxygen Saturation Levels is Associated with Response to Adaptive Servo-Ventilation Therapy in Heart Failure Patients

Patient-Ventilator Interaction During Noninvasive Ventilation

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