Adaptive servoventilation improves cardiac function and respiratory stability

Abstract

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.

Short-Term Prognosis of Adaptive Servo-Ventilation Therapy in Patients With Heart Failure

“…4 Values are mean ± standard deviation. Group A = moderate-to-severe SDB (AHI > -20), ASV-treated patients; Group B = moderate-to-severe SDB (AHI > -20), non-ASV-treated patients; Group C = non-to-mild SDB (AHI <20), ASV-treated patients; Group D = non-to-mild SDB (AHI <20), non-ASV-treated patients.…”

Cheyne-Stokes Respiration in Chronic Heart Failure

“…Thus, the final result might be more stable respiration with improved respiratory control. 30 OSA and CSA-CSR, in particular, are associated with increased sympathetic drive, 66 which is independently associated with poor prognosis in HF. 67, 68 In combination with other contributing factors such as oxygen desaturation, increased LV wall tension and afterload, and BP changes, this may lead to malignant ventricular arrhythmias, which have been documented in these patients.…”

“…28 Most HF patients with nocturnal CSA-CSR hyperventilate even while awake during the daytime. 8,29, 30 This hyperventilation may be a result of stimulation of pulmonary vagal irritant receptors by pulmonary congestion in combination with enhanced central and peripheral chemoreceptor sensitivity and prolonged circulation time. 31,32 In HF patients with CSA-CSR, carbon dioxide (CO2)-dependent apnea thresholds are altered, 33 making them more sensitive to apnea with decreasing CO2 partial pressure (pCO2).…”

“…56 A non-randomized controlled trial confirmed the findings of the observational study and also documented beneficial effects on cardiac remodeling (eg, a decrease in LV end-diastolic diameter) and improved respiratory control. 30 The acute effects of ASV in HF therefore appear to include a decrease in LV afterload and an increase in forward stroke volume. During chronic therapy, reversal of cardiac remodeling is accompanied by a reduction in (functional) mitral regurgitation.…”

Updated Adaptive Servo-Ventilation Recommendations for the 2012 AASM Guideline: “The Treatment of Central Sleep Apnea Syndromes in Adults: Practice Parameters with an Evidence-Based Literature Review and Meta-Analyses”

“…Left VentricuLar ejection fraction: Nineteen studies 5,[7][8][9][10][11][12][13][14][15]18,19,[22][23][24]27,29,32 reported on the effects of ASV on LVEF. The meta-analysis of the change in LVEF with treatment versus baseline is shown in Figure S1 in the supplemental material.…”