Cheyne-Stokes Respiration in Congestive Heart Failure: Continuous Positive Airway Pressure of 5–8 cm H₂O for 1 Year in Five Cases

Abstract

Five adult patients with congestive heart failure (CHF) due to dilated cardiomyopathy complicated by Cheyne-Stokes respiration/central sleep apnea (CSR/CSA) were treated with continuous positive airway pressure (CPAP) with an initial pressure of 5 cm H₂O. Four patients were followed up for 12 months with CPAP of 5 cm H₂O. The rest, a 93-year-old patient, was followed up for 30 months, and the CPAP was reset at 8 cm H₂O due to worsened cardiac function after 6 months and it was reset at 6 cm H₂O due to dryness of the nose after 23 months. For all the patients with nightly CPAP use for 6.0 ± 1.4 h per day for a year, frequency of CSR/CSA was significantly reduced after 3 and 12 months with CPAP (p < 0.05). Moreover, their symptoms, cardiac function and sleep quality were significantly improved after 3 months (p < 0.05), and were maintained above the pre-CPAP levels after 12 months, except for the oldest patient whose cardiac function tended to deteriorate. The results suggest that CSR/CSA in CHF can be treated with CPAP set at a lower pressure than the conventional method, and that CPAP at 5–8 cm H₂O is often effective in eliminating CSR/CSA, improving sleep quality, and presumably maintaining cardiac function.

Left Ventricular Response to Continuous Positive Airway Pressure: Role of Left Ventricular Geometry

“…These results were approved in further studies [17, 18]; moreover, the authors found a dose-related positive effect using different pressures (5 and 10 cm H 2 O). It was shown that CPAP at a level of 5–8 cm H 2 O was associated with an improvement of cardiac function and symptoms in 5 patients with heart failure and Cheyne-Stokes respiration [19]. In patients with normal left ventricular filling pressures and in normal controls, CPAP affected a decrease in cardiac index.…”

Preoperative Management of Deteriorating Mitral Regurgitation and Heart Failure with Continuous Positive Airway Pressure

“…In the present case, the CPAP was adjusted to 5-8 cmH2O, according to the method described by Yasuma (9,10), which is lower than the conventional optimal CPAP pressure of 10-12.5 cmH2O for patients with CHF (11). In contrast, Genovese et al demonstrated that, in pigs with pacinginduced CHF, the cardiac output and left ventricular ejection fraction were enhanced with the use of CPAP at a pressure of 5 cmH2O (12).…”

Should Cardiologists Treat Cheyne-Stokes Respiration and Congestive Heart Failure With Oxygen, Bi-Level/Continuous Positive Airway Pressures or Drugs Alone?

“…Thereafter, we applied this strategy to 5 consecutive heart failure patients with central sleep apnea for 6 h per night for 1 year with success. 8 Any of the aforementioned clinical investigations lacked the power to conclude with certainty that nightly oxygen, Bi-PAP or CPAP is effective in improving the morbidity or mortality of patients with congestive heart failure. 1,2,6,8 The interaction among sleep, respiration and circulation is a newly developing field in cardiology (the so-called new cardiovascular frontier 9 ), as indicated by the fact that only 17 years have passed since one of the earliest studies dealing with Cheyne-Stokes respiration in congestive heart failure appeared in this Journal.…”