Effects of captopril and oxygen on sleep apnoea in patients with mild to moderate congestive cardiac failure.

Abstract

Objectives-To determine the effects of captopril and oxygen on sleep quality in patients with mild to moderate cardiac failure.Design-An open observational study. Patients-12 patients with New York Heart Association class II-III heart failure were studied at baseline. 9 of these patients were then examined at the end of 1 month of treatment with captopril; 9 of the patients were separately assessed during a single night of supplementary oxygen.Main outcome measures-Sleep patterns by polysomnography, overnight oximetry, and subjective sleep assessment using visual analogue scores. Results-Abnormal sleep was present in all baseline studies. Complete polysomnograms after treatment with captopril were obtained in 8 patients. Light sleep (stages 1 and 2) was reduced (mean (SEM) 61%(8)% to 48%(6)% actual sleep time, P < 0.05) but slow wave (stages 3 and 4) and REM (rapid eye movement) sleep increased (25%(6)% to 31%(5)%, 14%(2)% to 21%(5)% actual sleep time, P < 0.05). Apnoeic episodes (242(59) to 118(30), P < 0-05), desaturation events (171(60) to 73(37), P < 0.05), and arousals (33(5) to 18(3) P < 0.01) were reduced. Visual analogue scores of sleep quality increased 49(5) to 69(5), P < 0.01). Complete polysomnograms were obtained in 7 patients treated with oxygen. Light sleep duration was reduced (55% (7)% to 42%(5)% actual sleep time, P < 0 05) and slow wave sleep increased (30%(5)% to 38%(6)% actual sleep time, P < 0.05). REM sleep duration was not significantly different. Total arousals (33(6)% to 20(2) P < 0.05), desaturation events (140(33) to 38(10), P < 0.01), and apnoeic episodes (212(53) to 157(33), P < 0.05) were reduced. Visual analogue scores of sleep quality were unchanged. Conclusions-Captopril and oxygen may improve sleep quality and reduce nocturnal desaturation in patients with mild to moderate cardiac failure. Improved sleep quality could explain the reduction in daytime symptoms seen after treatment in patients with chronic heart failure. (Br Heart3' 1995;73:237-241)

Sleep Apnea and Cardiovascular Disease

“…The introduction of angiotensin-converting enzyme inhibition can lower the AHI and reduce the nocturnal desaturation of patients with mild to moderate heart failure. 354 Diuresis with a reduction in cardiac filling pressure also has been shown to reduce the severity of CSA, 340 but in some patients, the resulting metabolic alkalosis may promote CSA by narrowing the difference between ambient PaCO 2 and the PaCO 2 threshold for apnea. 355,356 ␤-Adrenergic blockade, which counters excess sympathetic activation and may modulate ventilatory responses in heart failure, 18 has been reported to decrease AHI in patients with CSA.…”

Influence of Pulmonary Capillary Wedge Pressure on Central Apnea in Heart Failure

“…Moreover, new therapies that attenuate central apnea, namely, CPAP, oxygen, theophylline, or more intensive pharmacological therapy, have in recent times shown promise as adjunctive therapy for CHF. 3,[21][22][23] In summary, elevated PCWP in patients with severe yet stable CHF is associated with hypocapnia and central apnea. This observation is consistent with experimental data from animals that indicate that increased pulmonary vagal afferent nerve traffic secondary to pulmonary edema stimulates hyperventilation and hypocapnia.…”

Adaptive Servo Ventilation Improves Cardiac Dysfunction and Prognosis in Chronic Heart Failure Patients With Cheyne-Stokes Respiration

“…[30][31][32][33][34][35] The present study included 12 patients at least 12 months after CRT implantation, and CSR-CSA and depressed cardiac function still remained in spite of standard pharmacotherapy and CRT in these patients.…”