Effect of Nasal Continuous Positive Airway Pressure on Sleep Apnea in Congestive Heart Failure

Takasaki, Yoshito; D, Orr; Popkin, J.; Rutherford, R; Liu, P; Bradley, T. Douglas

doi:10.1164/ajrccm/140.6.1578

Cited by 148 publications

(103 citation statements)

References 8 publications

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“…One advantage of this study compared to previous work is that the selection of subjects was guided by restrictive inclusion and exclusion criteria to avoid the confounding effects of comorbidity. Previous studies with similar design [11,28,35] might have been biased, because they were not controlled for cofounders influencing the control of breathing, such as medication and stroke, or the underlying cardiac rhythm.…”

Section: Discussionmentioning

confidence: 99%

Assisted ventilation for heart failure patients with Cheyne-Stokes respiration

Köhnlein¹,

Welte²,

Tan³

et al. 2002

European Respiratory Journal

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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.

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Section: Discussionmentioning

confidence: 99%

Assisted ventilation for heart failure patients with Cheyne-Stokes respiration

Köhnlein¹,

Welte²,

Tan³

et al. 2002

European Respiratory Journal

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“…CPAPhas been widely used as a mechanical and non-pharmacological treatment for sleep disordered breathing since its first use in patients with obstructive sleep apnea by Sullivan et al in 1981 (16). Whereas, the use ofCPAP in patients of CHF presenting with CSR was first described by Takasaki et al in 1989 ( 15). A patient treated with CPAP of non-pharmacological respiratory and/or circulatory support can avoid any potential side effects of drugs, which are administered systematically for treatment of CHF.…”

Section: Discussionmentioning

confidence: 99%

“…Continuous positive airway pressure (CPAP), a mechanical and non-pharmacological treatment for sleep apnea, can result in improvement in the severity of CHF (13)(14)(15). Here, we present a CHFpatient of the ninth decade of life with ischemic dilated cardiomyopathy, who experienced a long-term benefit with nocturnal CPAPthrough a nasal mask.…”

Section: Introductionmentioning

confidence: 99%

Long-term Treatment of Ischemic Dilated Cardiomyopathy with Continuous Positive Airway Pressure.

Yasuma

Ogihara

2001

Intern. Med.

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An 81-year-old man with ischemic dilated cardiomyopathy complained of frequently awakening from sleep due to choking; subsequent polysomnography revealed CheyneStokes respiration (CSR) with sleep apnea. With continuous positive airway pressure (CPAP) through a nasal mask, both the CSRand symptoms disappeared. After 6-12 months, chest X-ray and echocardiographic findings continued to improve without any change in pharmacological treatment. For three years, CPAPhad been effective to eliminate CSRduring sleep. Long-term CPAPtreatment, which is rarely applied for congestive heart failure in Japan, is useful in alleviating the adverse effects of CSRand, thereby, maintaining a good quality of life in these patients.

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“…It is noteworthy in this context that continuous positive airway pressure (CPAP), which dilates and stabilizes the upper airway, 64,65 has been shown to alleviate CheyneStokes. 66,67,68 These data must be interpreted with caution because CPAP has many other effects that could damp periodic breathing by a indirect mechanism other than stabilization of the upper airway. Continuous positive airway pressure is an effective treatment for the failing heart, not only because it inflates the lungs but also because it augments cardiac performance by decreasing pre and after load.…”

Section: Contributing Factors To Respiratory Instabilitymentioning

confidence: 97%

“…It also improved quality of life and survival. 23,67,68,79,84,85 Oxygen administration has been shown to cause a modest reduction in the severity of Cheyne-Stokes respiration, to reduce overnight urinary norepinephrine levels, and cause an increase in peak O 2 consumption during graded exercise over periods of 1 to 4 weeks. [53][54][55][56][57] Finally, theophylline has been shown to reduce the severity of CheyneStokes over 5 days, but has not been shown to improve cardiac function, neurohumoral activity, or quality of life.…”

Section: Consequences Of Cheyne-stokes Respirationmentioning

confidence: 99%

Cheyne-Stokes Respiration in Patients With Congestive Heart Failure: Causes and Consequences

Lorenzi-Filho¹,

Genta

Figueiredo

et al. 2005

Clinics

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Cheyne-Stokes respiration is a form of periodic breathing in which central apneas and hypopneas alternate with periods of hyperventilation, producing a waxing and waning pattern of tidal volume. This review focuses on the causes and consequences of Cheyne-Stokes respiration in patients with congestive heart failure, in whom the prevalence is strikingly high and ranges from 30% to 50%. Several factors have been implicated in the genesis of Cheyne-Stokes respiration, including low cardiac output and recurrent hypoxia. The key pathophysiological mechanism triggering Cheyne-Stokes respiration is hyperventilation and low arterial CO 2 (PaCO 2 ) that when below the apneic threshold triggers a central apnea. Hyperventilation is associated with pulmonary congestion, and Cheyne-Stokes respiration is more prone to occur during sleep, when the respiratory system is mainly dependent on chemical control. It is associated with recurrent dips in oxygen saturation and arousals from sleep, with oscillations in blood pressure and heart rate, sympathetic activation and increased risk of ventricular tachycardia. Cheyne-Stokes respiration is an independent marker of poor prognosis and may participate in a vicious cycle, further stressing the failing heart.

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Effect of Nasal Continuous Positive Airway Pressure on Sleep Apnea in Congestive Heart Failure

Cited by 148 publications

References 8 publications

Assisted ventilation for heart failure patients with Cheyne-Stokes respiration

Assisted ventilation for heart failure patients with Cheyne-Stokes respiration

Long-term Treatment of Ischemic Dilated Cardiomyopathy with Continuous Positive Airway Pressure.

Cheyne-Stokes Respiration in Patients With Congestive Heart Failure: Causes and Consequences

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