Efficacy of adaptive-servo ventilation (HEART PAP™) for an elderly patient with chronic heart failure who had Cheyne–Stokes respiration with central sleep apnea

Abstract

An 82-year-old male patient, who had been diagnosed with chronic heart failure due to dilated cardiomyopathy and combined valvular disease and who had atrial fibrillation with complete atrioventricular block, was admitted to our hospital owing to the exacerbation of chronic heart failure. During admission, the patient became aware of drowsiness during daytime hours and had periodic apnea during sleep. Polysomnography (PSG) revealed Cheyne-Stokes respiration with severe central sleep apnea as evidenced by an apnea-hypopnea index (AHI) of 93.5/h. Nocturnal oxygen therapy failed to sufficiently suppress apnea, and arousal reactions occurred frequently. Therefore, we conducted titration by adaptive-servo ventilation (ASV; HEART PAP TM ). Consequently, subjective symptoms and respiratory sleep parameters improved. The patient showed excellent adherence to loading the device at home. PSG at 3 months after implementation of HEART PAP TM indicated improvement in the AHI to 13.5/h, and the patient exhibited marked improvements in breathlessness and awareness of drowsiness during daytime hours. HEART PAP TM was found to be a useful device for Cheyne-Stokes respiration with central sleep apnea that is associated with chronic heart failure even for very elderly patients.

Successful adaptive servo-ventilation for patients with acute cardiogenic pulmonary edema due to severe aortic stenosis

“…Recently, noninvasive ventilation such as continuous positive air way pressure (CPAP) or noninvasive intermittent positive pressure ventilation (NIPPV) has been shown to avert tracheal intubation by improving oxygenation with favorable hemodynamic effects [3,4]. Adaptive servoventilation (ASV) has been widely accepted as one of the new therapies for patients with heart failure, especially, with Cheyne-Stokes respiration [5][6][7][8][9]. ASV has been postulated to have several physiological advantages compared to CPAP and NIPPV.…”