Hypotensive effects of positive airway pressure ventilation in heart failure patients with sleep-disordered breathing

Oldenburg, Olaf; Bartsch, Stephan; Bitter, Thomas; Schmalgemeier, Heidi; Fischbach, Thomas; Westerheide, Nina; Horstkotte, Dieter

doi:10.1007/s11325-011-0571-4

Cited by 30 publications

(19 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…High EPAP in severe HF patients with low filling pressures and/or low resting BP may result in unexpected drops in BP [18]. However, the EPAP automatically set by the intelligent algorithm in the PaceWave™ device was comparable to that manually titrated when the AutoSet™CS was used.…”

Section: Discussionmentioning

confidence: 96%

See 1 more Smart Citation

Performance of conventional and enhanced adaptive servoventilation (ASV) in heart failure patients with central sleep apnea who have adapted to conventional ASV

et al. 2014

Self Cite

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 96%

“…Since its first use more than a decade ago, evidence regarding the beneficial effects of ASV in HF patients with CSA-CSR is accumulating. These include improvements in quality of life, exercise tolerance, cardiac and cardiovascular function, and rehospitalization rate [15,[17][18][19][20][21][22][23][24].…”

Section: Introductionmentioning

confidence: 99%

Performance of conventional and enhanced adaptive servoventilation (ASV) in heart failure patients with central sleep apnea who have adapted to conventional ASV

et al. 2014

Self Cite

View full text Add to dashboard Cite

show abstract

“…Of note, with a same titrated minimum EPAP value programmed, D3 supplied a higher EPAP pressure than the other two devices up to values which may be deleterious to some heart failure patients (13.2 cm H 2 O for D3 vs. 9.8 and 9.3 cm H 2 O for D1 and D2, respectively during the entire tests, Figure 5B). 30,31 On the scoring side, the number of residual apneas of the three devices with the maximum settings was roughly the same as the bench value, while D1 and D3 distinguished and slightly overestimated OA (Figure 9A). However, with clinical settings, the devices overestimated apneas, except D1 ( Figure 9B).…”

mentioning

confidence: 79%

Bench Test Evaluation of Adaptive Servoventilation Devices for Sleep Apnea Treatment

Zhu

Kharboutly²,

Ma³

et al. 2013

Journal of Clinical Sleep Medicine

View full text Add to dashboard Cite

Rationale: Adaptive servoventilation devices are marketed to overcome sleep disordered breathing with apneas and hypopneas of both central and obstructive mechanisms often experienced by patients with chronic heart failure. The clinical effi cacy of these devices is still questioned. Study Objectives: This study challenged the detection and treatment capabilities of the three commercially available adaptive servoventilation devices in response to sleep disordered breathing events reproduced on an innovative bench test. Methods:The bench test consisted of a computer-controlled piston and a Starling resistor. The three devices were subjected to a fl ow sequence composed of central and obstructive apneas and hypopneas including Cheyne-Stokes respiration derived from a patient. The responses of the devices were separately evaluated with the maximum and the clinical settings (titrated expiratory positive airway pressure), and the detected events were compared to the bench-scored values. Results: The three devices responded similarly to central events, by increasing pressure support to raise airfl ow. All central apneas were eliminated, whereas hypopneas remained. The three devices responded differently to the obstructive events with the maximum settings. These obstructive events could be normalized with clinical settings. The residual events of all the devices were scored lower than bench test values with the maximum settings, but were in agreement with the clinical settings. However, their mechanisms were misclassifi ed. Conclusion:The tested devices reacted as expected to the disordered breathing events, but not suffi ciently to normalize the breathing fl ow. The device-scored results should be used with caution to judge effi cacy, as their validity depends upon the initial settings. S C I E N T I F I C I N V E S T I G A T I O N SA uto-titrating continuous positive airway pressure ventilators (auto-CPAP) have been developed by manufacturers for the treatment of obstructive sleep apnea with the assumption that lower pressure application would be more comfortable and thus improve compliance and long-term patient outcomes. 1,2However, a recent meta-analysis of auto-CPAP devices has found a limited clinical relevance of only 0.2 h per night of additional use compared to common CPAP devices.3 Clinical studies have recently shown that this limitation may be due to a failure of auto-CPAP devices to reliably estimate the therapeutic pressure in up to 25% of patients. [4][5][6][7] It is noteworthy that bench testing of these devices has predicted these detection and response limitations under simulated obstructive events. [8][9][10][11] More recently, some manufacturers have developed new devices based on adaptive servoventilation (ASV) to treat patients with mixed events of alternating central and obstructive mechanisms as observed in heart failure 12 or so-called complex sleep apnea (CompSA). 13 These ASV devices apply a closed-loop mechanical ventilation, pressure preset, and volume or airfl ow cycled.14 The aim of thes...

show abstract

“…At least a transient drop in mean arterial pressure (to ≤70 mmHg) has been documented in approximately 10% of HF patients starting PAP therapy. 42 A major risk factor for this hypotensive effect is low baseline BP. However, it remains to be determined whether this drop in BP is sustained and/or this hypotensive reaction has a negative effect on patients' compliance with PAP therapy.…”

Section: Adaptive Servoventilation Therapy (Asv)mentioning

confidence: 99%

Cheyne-Stokes Respiration in Chronic Heart Failure

Oldenburg

2012

Circ J

Self Cite

View full text Add to dashboard Cite

Sleep-disordered breathing (SDB) with predominant obstructive or central sleep apnea (OSA/CSA) with CheyneStokes respiration (CSR) is a common, but underestimated and underappreciated, comorbidity in patients with heart failure (HF). Regardless of the type of HF (systolic or diastolic) or its etiology (ischemic, non-ischemic, valvular etc), the prevalence of SDB is remarkably high in this patient group, at 70-76%. Even more so in HF than in the general population, OSA and CSA in particular are independently associated with an impaired prognosis. This review details the pathophysiology of CSA-CSR in HF, highlights the challenges and tools available for diagnosis, explains the concept of adaptive servoventilation (ASV) therapy, and summarizes the existing literature on the use of ASV therapy in HF patients in general and HF with reduced ejection fraction in particular. (Circ J 2012; 76: 2305 -2317 Key Words: Adaptive servoventilation; Cheyne-Stokes respiration; Heart failure; Sleep-disordered breathing Figure 1. Scheme of the relative prevalence and importance of obstructive (OSA) and central sleep apnea (CSA) according to heart failure severity. With increasing impairment in cardiac function there is an increase in CSA prevalence. NYHA, New York Heart Association class.

show abstract

Hypotensive effects of positive airway pressure ventilation in heart failure patients with sleep-disordered breathing

Cited by 30 publications

References 15 publications

Performance of conventional and enhanced adaptive servoventilation (ASV) in heart failure patients with central sleep apnea who have adapted to conventional ASV

Performance of conventional and enhanced adaptive servoventilation (ASV) in heart failure patients with central sleep apnea who have adapted to conventional ASV

Bench Test Evaluation of Adaptive Servoventilation Devices for Sleep Apnea Treatment

Cheyne-Stokes Respiration in Chronic Heart Failure

Contact Info

Product

Resources

About