Nasal Continuous Positive Airway Pressure in Chronic Heart Failure with Sleep-disordered Breathing

Abstract

Nasal continuous positive airway pressure (NCPAP) has been reported to improve daytime symptoms in patients with sleep disordered breathing due to heart failure. To examine this in a controlled manner, eight men with stable chronic heart failure (mean left ventricular ejection fraction 18% and mean frusemide dose 160 mg) were entered into a controlled trial of domiciliary nocturnal NCPAP. At polysomnography (with sleep apnea quantified as the number of > 4% dips in arterial saturation per hour), seven had nocturnal Cheyne-Stokes respiration (SaO2 dip rate 3 to 27/hr), and one both central and obstructive apneas (SaO2 dip rate 8/hr). After 2 wk nocturnal domiciliary NCPAP at < 1.5 cm H2O (placebo) and 7.5 cm H2O (active) in random order, bicycle exercise tolerance and heart failure symptoms (modified Likert questionnaire) were assessed by an observer unaware of the patients' NCPAP status. Pulse oximetry (all subjects) and radionuclide estimated left ventricular ejection fraction (three subjects) were also measured at the end of each period. Two subjects withdrew from the study because of worsening heart failure during active NCPAP (7.5 cm H2O), and one of these subjects died. In the remaining six subjects exercise tolerance, symptom scores, and the severity of sleep apnea were similar on active NCPAP compared with placebo. When it was measured, resting left ventricular ejection fraction was lower on active therapy than on placebo. These data exclude a 25% improvement in exercise tolerance with 95% confidence and suggest that a study of 160 subjects would be needed to exclude a 10% change in symptom score.(ABSTRACT TRUNCATED AT 250 WORDS)

The Control of Breathing in Clinical Practice

“…104 This novel treatment remains experimental, as others have not reproduced these findings. 105 Supplemental oxygen may be used as treatment and tends to eliminate or decrease CSR in congestive heart failure by eliminating hypoxemia, which contributes to respiratory cycling. 106 CSR secondary to heart failure may also be treated with oral theophylline.…”

Acute and chronic effects of continuous positive airway pressure therapy on left ventricular systolic and diastolic function in patients with obstructive sleep apnea and congestive heart failure

“…In contrast, conflicting hemodynamic effects have been reported in stable CHF patients receiving acute CPAP therapy. Some investigators have reported an increase in stroke volume and cardiac output with acute CPAP therapy (18), while others have observed no change or a decrease in cardiac output (20,21). An improvement in left ventricular ejection fraction (LVEF) has been observed in patients with CHF who receive chronic CPAP therapy (22)(23)(24).…”

Tratamento da respiração de Cheyne-Stokes em pacientes com insuficiência cardíaca congestiva

“…Contrarily, other authors have shown that CPAP failed to improve CSR 14,15 , or even showed that it can be deleterious for these patients 15 . A methodological error that might have contributed to the lack of success of CPAP was the protocol used in pressure adjustment, initiated arbitrarily at 7.5 cmH 2 O or higher.…”