Assisted ventilation for heart failure patients with Cheyne-Stokes respiration

Abstract

Patients with chronic congestive cardiac failure (CCF) frequently suffer from central sleep apnoea syndrome (CSAS). Continuous positive airway pressure (CPAP) has been suggested as a treatment. The authors hypothesised that bilevel ventilation might be easier to initiate and superior to CPAP at correcting the sleeprelated abnormality of breathing in patients with CCF.After excluding those with a history suggestive of obstructive sleep apnoea, 35 patients with CCF (left ventricular ejection fraction v35%) were screened with overnight oximetry and the diagnosis of CSAS was established with polysomnography in 18. Two 14-day cycles of CPAP (0.85 kPa (8.5 mbar)) or bilevel ventilation (0.85/0.3 kPa (8.5/3 mbar)) in random order, were compared in a crossover study.Sixteen patients (13 males), mean age 62.0 ¡ 7.4 yrs completed the study. The pretreatment apnoea/hypopnoea index of 26.7¡10.7 was significantly reduced by CPAP and bilevel ventilation to 7.7¡5.6 and 6.5¡6.6, respectively. The arousal index fell from 31.1¡10.0 per hour of sleep to 15.7¡5.4 and 16.4¡6.9, respectively. Significant and equal improvements with CPAP and bilevel ventilation were found for sleep quality, daytime fatigue, circulation time and New York Heart Association class.The authors conclude that continuous positive airway pressure and bilevel ventilation equally and effectively improve Cheyne-Stokes respiration in patients with congestive cardiac failure. Eur Respir J 2002; 20: 934-941.

Treatment of Central Sleep Apnea in US Veterans

“…Thus, therapeutic options have varied markedly from positive airway pressure (PAP) devices, including continuous positive airway pressure (CPAP), [2][3][4][5][6] bilevel positive airway pressure therapy (BPAP), [7][8][9] and adaptive servoventilation, [10][11][12][13]20 to supplemental O 2 , 14-17 carbon dioxide, 21,22 and/or pharmacologic agents. [23][24][25]29,30 The outcomes of therapy have also varied considerably, with limited evidence to establish the effectiveness of any therapy for CSA. [26][27][28][29]31,32 The majority of published literature has focused on the treatment of CSA secondary to congestive heart failure (CHF), [2][3][4][5][6][7][8][9][10][11][15][16][17][18][19][20][21][22][26][27][28]…”

Tratamento da respiração de Cheyne-Stokes em pacientes com insuficiência cardíaca congestiva

“…Its effects are also maintained during the day as observed in the LV EF improvement 2,11,12 , in the NYHA classification of CHF 2,9,11,12 , in the reduction of diurnal somnolence at the Epworth scale and decreased heart frequency during the state of wakefulness 11 . It also decreases the sympathetic activity by reducing the concentrations of nocturnal urinary norepinephrine and morning plasma norepinephrine 2 and decreases the frequency of ventricular arrhythmias 10 .…”

“…The non-responders had a mean AHI of 62 and the responders, a mean AHI of 36, which shows that more severe patients may not respond to CPAP, probably due to the fact that the latter can lead to a tendency to wake up, promoting respiratory instability due to the more elevated pressures used in these patients. Other studies have found a higher frequency of responders, but they had less severe cohorts 9 .…”

“…Several studies have shown the effects of CPAP on CSR of patients with cardiopathies, by reducing the central apnea/hypopnea index (AHI) 2,5,[8][9][10][11][12] , improving nocturnal oxyhemoglobin saturation (SatO 2 ) 2,[8][9][10]12 , decreasing the time of CSR during sleep 9 and the number of brief awakenings [9][10][11][12] , increasing the percentage of slow-wave sleep 9,12 . Its effects are also maintained during the day as observed in the LV EF improvement 2,11,12 , in the NYHA classification of CHF 2,9,11,12 , in the reduction of diurnal somnolence at the Epworth scale and decreased heart frequency during the state of wakefulness 11 .…”

“…Another method of ventilation with positive pressure (Bilevel Positive Airway Pressure, BiPAP) was compared to CPAP, but did not show any advantage when compared to the latter, in addition to its very high cost 9 .…”