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Pinto ACPN, Rocha A, Pachito DV, Drager LF, Lorenzi-Filho G. Non-invasive positive pressure ventilation for central sleep apnoea in adults. Cochrane Database Syst Rev 2022; 10:CD012889. [PMID: 36278514 PMCID: PMC9590003 DOI: 10.1002/14651858.cd012889.pub2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Central sleep apnoea (CSA) is characterised by abnormal patterns of ventilation during sleep due to a dysfunctional drive to breathe. Consequently, people with CSA may present poor sleep quality, sleep fragmentation, inattention, fatigue, daytime sleepiness, and reduced quality of life. OBJECTIVES To assess the effectiveness and safety of non-invasive positive pressure ventilation (NIPV) for the treatment of adults with CSA. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and Scopus on 6 September 2021. We applied no restrictions on language of publication. We also searched clinical trials registries for ongoing and unpublished studies, and scanned the reference lists of included studies to identify additional studies. SELECTION CRITERIA We included randomised controlled trials (RCTs) reported in full text, those published as abstract only, and unpublished data. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies for inclusion, extracted data, and assessed risk of bias of the included studies using the Cochrane risk of bias tool version 1.0, and the certainty of the evidence using the GRADE approach. In the case of disagreement, a third review author was consulted. MAIN RESULTS We included 15 RCTs with a total of 1936 participants, ranging from 10 to 1325 participants. All studies had important methodological limitations. We assessed most studies (11 studies) as at high risk of bias for at least one domain, and all studies as at unclear risk of bias for at least two domains. The trials included participants aged > 18 years old, of which 70% to 100% were men, who were followed from one week to 60 months. The included studies assessed the effects of different modes of NIPV and CSA. Most participants had CSA associated with chronic heart failure. Because CSA encompasses a variety of causes and underlying clinical conditions, data were carefully analysed, and different conditions and populations were not pooled. The findings for the primary outcomes for the seven evaluated comparisons are presented below. Continuous positive airway pressure (CPAP) plus best supportive care versus best supportive care in CSA associated with chronic heart failure In the short term, CPAP plus best supportive care may reduce central apnoea hypopnoea index (AHI) (mean difference (MD) -14.60, 95% confidence interval (CI) -20.11 to -9.09; 1 study; 205 participants). However, CPAP plus best supportive care may result in little to no difference in cardiovascular mortality compared to best supportive care alone. The evidence for the effect of CPAP plus best supportive care on all-cause mortality is very uncertain. No adverse effects were observed with CPAP, and the results for adverse events in the best supportive care group were not reported. Adaptive servo ventilation (ASV) versus CPAP in CSA associated with chronic heart failure The evidence is very uncertain about the effect of ASV versus CPAP on quality of life evaluated in both the short and medium term. Data on adverse events were not reported, and it is not clear whether data were sought but not found. ASV versus bilevel ventilation in CSA associated with chronic heart failure In the short term, ASV may result in little to no difference in central AHI. No adverse events were detected with ASV, and the results for adverse events in the bilevel ventilation group were not reported. ASV plus best supportive care versus best supportive care in CSA associated with chronic heart failure In the medium term, ASV plus best supportive care may reduce AHI compared to best supportive care alone (MD -20.30, 95% CI -28.75 to -11.85; 1 study; 30 participants). In the long term, ASV plus best supportive care likely increases cardiovascular mortality compared to best supportive care (risk ratio (RR) 1.25, 95% CI 1.04, 1.49; 1 study; 1325 participants). The evidence suggests that ASV plus best supportive care may result in little to no difference in quality of life in the short, medium, and long term, and in all-cause mortality in the medium and long term. Data on adverse events were evaluated but not reported. ASV plus best supportive care versus best supportive care in CSA with acute heart failure with preserved ejection fraction Only adverse events were reported for this comparison, and no adverse events were recorded in either group. ASV versus CPAP maintenance in CPAP-induced CSA In the short term, ASV may slightly reduce central AHI (MD -4.10, 95% CI -6.67 to -1.53; 1 study; 60 participants), but may result in little to no difference in quality of life. Data on adverse events were not reported, and it is not clear whether data were sought but not found. ASV versus bilevel ventilation in CPAP-induced CSA In the short term, ASV may slightly reduce central AHI (MD -8.70, 95% CI -11.42 to -5.98; 1 study; 30 participants) compared to bilevel ventilation. Data on adverse events were not reported, and it is not clear whether data were sought but not found. AUTHORS' CONCLUSIONS CPAP plus best supportive care may reduce central AHI in people with CSA associated with chronic heart failure compared to best supportive care alone. Although ASV plus best supportive care may reduce AHI in people with CSA associated with chronic heart failure, it likely increases cardiovascular mortality in these individuals. In people with CPAP-induced CSA, ASV may slightly reduce central AHI compared to bilevel ventilation and to CPAP. In the absence of data showing a favourable impact on meaningful patient-centred outcomes and defining clinically important differences in outcomes in CSA patients, these findings need to be interpreted with caution. Considering the level of certainty of the available evidence and the heterogeneity of participants with CSA, we could draw no definitive conclusions, and further high-quality trials focusing on patient-centred outcomes, such as quality of life, quality of sleep, and longer-term survival, are needed to determine whether one mode of NIPV is better than another or than best supportive care for any particular CSA patient group.
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Affiliation(s)
- Ana Carolina Pereira Nunes Pinto
- Cochrane Brazil, Health Technology Assessment Center, São Paulo, Brazil
- Biological and Health Sciences Department, Federal University of Amapa, Amapá, Brazil
- Post-graduation program in Evidence-based Health, Department of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Aline Rocha
- Cochrane Brazil, Núcleo de Avaliação de Tecnologias em Saúde, São Paulo, Brazil
| | | | - Luciano F Drager
- Unidade de Hipertensão, Disciplina de Nefrologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
- Unidade de Hipertensão, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
- Cardiology Center, Hospital Sírio Libanes, São Paulo, Brazil
| | - Geraldo Lorenzi-Filho
- Laboratorio de Sono, Divisao de Pneumologia, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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Hu WH, Khoo MCK. Treatment of Cheyne-Stokes Respiration in Heart Failure with Adaptive Servo-Ventilation: An Integrative Model. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2022; 1384:79-103. [PMID: 36217080 DOI: 10.1007/978-3-031-06413-5_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The SERVE-HF (Treatment of Predominant Central Sleep Apnea by Adaptive Servo Ventilation in Patients with Heart Failure) multicenter trial found a small but significant increase in all-cause and cardiovascular mortality in patients assigned to adaptive servo-ventilation (ASV) versus guideline-based medical treatment. To better understand the physiological underpinnings of this clinical outcome, we employ an integrative computer model to simulate congestive heart failure with Cheyne-Stokes respiration (CHF-CSR) in subjects with a broad spectrum of underlying pathogenetic mechanisms, as well as to determine the in silico changes in cardiopulmonary and autonomic physiology resulting from ASV. Our simulation results demonstrate that while the elimination of CSR through ASV can partially restore cardiorespiratory and autonomic physiology toward normality in the vast majority of CHF phenotypes, the degree of restoration can be highly variable, depending on the combination of CHF mechanisms in play. The group with the lowest left ventricular ejection fraction (LVEF) appears to be most vulnerable to the potentially adverse effects of ASV, but the level of pulmonary capillary wedge pressure (PCWP) plays an important role in determining the nature of these effects.
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Patterns of adaptive servo-ventilation settings in a real-life multicenter study: pay attention to volume! : Adaptive servo-ventilation settings in real-life conditions. Respir Res 2020; 21:243. [PMID: 32957983 PMCID: PMC7507637 DOI: 10.1186/s12931-020-01509-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 09/13/2020] [Indexed: 01/03/2023] Open
Abstract
Backgrounds To explain the excess cardiovascular mortality observed in the SERVE-HF study, it was hypothesized that the high-pressure ASV default settings used lead to inappropriate ventilation, cascading negative consequences (i.e. not only pro-arrythmogenic effects through metabolic/electrolyte abnormalities, but also lower cardiac output). The aims of this study are: i) to describe ASV-settings for long-term ASV-populations in real-life conditions; ii) to describe the associated minute-ventilations (MV) and therapeutic pressures for servo-controlled-flow versus servo-controlled-volume devices (ASV-F Philips®-devices versus ASV-V ResMed®-devices). Methods The OTRLASV-study is a cross-sectional, 5-centre study including patients who underwent ASV-treatment for at least 1 year. The eight participating clinicians were free to adjust ASV settings, which were compared among i) initial diagnosed sleep-disordered-breathing (SBD) groups (Obstructive-Sleep-Apnea (OSA), Central-Sleep-Apnea (CSA), Treatment-Emergent-Central-Sleep-Apnea (TECSA)), and ii) unsupervised groups (k-means clusters). To generate these clusters, baseline and follow-up variables were used (age, sex, body mass index (BMI), initial diagnosed Obstructive-Apnea-Index, initial diagnosed Central-Apnea-Index, Continuous-Positive-Airway-Pressure used before ASV treatment, presence of cardiopathy, and presence of a reduced left-ventricular-ejection-fraction (LVEF)). ASV-data were collected using the manufacturer’s software for 6 months. Results One hundred seventy-seven patients (87.57% male) were analysed with a median (IQ25–75) initial Apnea-Hypopnea-Index of 50 (38–62)/h, an ASV-treatment duration of 2.88 (1.76–4.96) years, 61.58% treated with an ASV-V. SDB groups did not differ in ASV settings, MV or therapeutic pressures. In contrast, the five generated k-means clusters did (generally described as follows: (C1) male-TECSA-cardiopathy, (C2) male-mostly-CSA-cardiopathy, (C3) male-mostly-TECSA-no cardiopathy, (C4) female-mostly-elevated BMI-TECSA-cardiopathy, (C5) male-mostly-OSA-low-LVEF). Of note, the male-mostly-OSA-low-LVEF-cluster-5 had significantly lower fixed end-expiratory-airway-pressure (EPAP) settings versus C1 (p = 0.029) and C4 (p = 0.007). Auto-EPAP usage was higher in the male-mostly-TECSA-no cardiopathy-cluster-3 versus C1 (p = 0.006) and C2 (p < 0.001). MV differences between ASV-F (p = 0.002) and ASV-V (p < 0.001) were not homogenously distributed across clusters, suggesting specific cluster and ASV-algorithm interactions. Individual ASV-data suggest that the hyperventilation risk is not related to the cluster nor the ASV-monitoring type. Conclusions Real-life ASV settings are associated with combinations of baseline and follow-up variables wherein cardiological variables remain clinically meaningful. At the patient level, a hyperventilation risk exists regardless of cluster or ASV-monitoring type, spotlighting a future role of MV-telemonitoring in the interest of patient-safety. Trial registration The OTRLASV study was registered on ClinicalTrials.gov (Identifier: NCT02429986). 1 April 2015.
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Heidbreder A, Spießhöfer J, Stypmann J, Boentert M, Young P, Duning T. Microstructural cerebral lesions are associated with the severity of central sleep apnea with Cheyne-Stokes-respiration in heart failure and are modified by PAP-therapy. Respir Physiol Neurobiol 2017; 247:181-187. [PMID: 29102807 DOI: 10.1016/j.resp.2017.10.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 10/27/2017] [Accepted: 10/28/2017] [Indexed: 10/18/2022]
Abstract
This study investigated the association of microstructural cerebral lesions with central sleep apnea with Cheyne-Stokes-respiration (CSA-CSR) in heart failure (HF) patients and the effect of positive airway pressure therapy (PAP) of CSA-CSR on these lesions. PAP-therapy was initiated in patients with HF with midrange and with reduced ejection fraction (NYHA≥II; left ventricular ejection fraction <50%) and proven CSA-CSR. Cerebral magnetic resonance imaging (MRI) scans at 3T including diffusion tensor imaging were obtained before and after 4 months of PAP-therapy. Cerebral MRI scans revealed microstructural lesions in all 11 patients with HF with midrange or reduced ejection fraction and CSA-CSR (64±8years, 82% male, left ventricular ejection fraction 37±11%) that were focussed on the brainstem and frontal cerebral regions. This microstructural damage correlated with the severity of CSA-CSR and 4 months of PAP-therapy lead to voxel clusters of altered fiber integrity in these lesions. Microstructural cerebral lesions might contribute to the pathophysiology of CSA-CSR in HF. In these patients PAP-therapy induces neuronal plasticity.
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Affiliation(s)
- Anna Heidbreder
- Department of Neurology, University Hospital of Muenster, Muenster, Germany; Department of Sleep Medicine and Neuromuscular Disorders, University Hospital Muenster, Germany
| | - Jens Spießhöfer
- Department of Neurology, University Hospital of Muenster, Muenster, Germany; Department of Sleep Medicine and Neuromuscular Disorders, University Hospital Muenster, Germany; Department of Cardiology, Pulmonology, and Vascular Medicine, Heinrich Heine University Medical Center Duesseldorf, Duesseldorf, Germany.
| | - Jörg Stypmann
- Department of Cardiovascular Medicine, Division of Cardiology, University Hospital Muenster, Germany
| | - Matthias Boentert
- Department of Neurology, University Hospital of Muenster, Muenster, Germany; Department of Sleep Medicine and Neuromuscular Disorders, University Hospital Muenster, Germany
| | - Peter Young
- Department of Neurology, University Hospital of Muenster, Muenster, Germany; Department of Sleep Medicine and Neuromuscular Disorders, University Hospital Muenster, Germany
| | - Thomas Duning
- Department of Neurology, University Hospital of Muenster, Muenster, Germany
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Abstract
Sleep-disordered breathing (SDB) is frequently observed in patients with heart failure (HF), and complex pathologic conditions exist between both conditions. In this review article, we describe the characteristics of SDB complicated with HF, the prognostic impact of SDB in HF patients, and the favorable effects of positive airway pressure in HF patients with SDB.
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Affiliation(s)
- Akiomi Yoshihisa
- Department of Cardiovascular Medicine, Fukushima Medical University
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Abstract
Awareness of the importance of sleep-related disorders in patients with cardiovascular diseases is growing. In particular, sleep-disordered breathing, short sleep time, and low sleep quality are frequently reported by patients with heart failure (HF). Sleep-disordered breathing, which includes obstructive sleep apnoea (OSA) and central sleep apnoea (CSA), is common in patients with HF and has been suggested to increase the morbidity and mortality in these patients. Both OSA and CSA are associated with increased sympathetic activation, vagal withdrawal, altered haemodynamic loading conditions, and hypoxaemia. Moreover, OSA is strongly associated with arterial hypertension, the most common risk factor for cardiac hypertrophy and failure. Intrathoracic pressure changes are also associated with OSA, contributing to haemodynamic alterations and potentially affecting overexpression of genes involved in ventricular remodelling. HF treatment can decrease the severity of both OSA and CSA. Indeed, furosemide and spironolactone administration, exercise training, cardiac resynchronization therapy, and eventually heart transplantation have shown a positive effect on OSA and CSA in patients with HF. At present, whether CSA should be treated and, if so, which is the optimal therapy is still debated. By contrast, more evidence is available on the beneficial effects of OSA treatment in patients with HF.
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Affiliation(s)
- Lee K Brown
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, School of Medicine, and the Department of Electrical and Computer Engineering, School of Engineering, University of New Mexico, Albuquerque, NM.
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Impact of SERVE-HF on management of sleep disordered breathing in heart failure: a call for further studies. Clin Res Cardiol 2016; 105:563-70. [PMID: 26872963 DOI: 10.1007/s00392-016-0970-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Accepted: 02/01/2016] [Indexed: 12/27/2022]
Abstract
Sleep disordered breathing (SDB) (obstructive sleep apnea, central sleep apnea/Cheyne-Stokes respiration or the combination of both) is highly prevalent in patients with a wide variety of cardiovascular diseases including hypertension, arrhythmia, coronary artery disease, myocardial infarction and stroke (reviewed previously in the September issue of this journal). Its close association with outcomes in chronic heart failure with reduced ejection fraction (HF-REF) suggests that it may be a potential treatment target. Herein, we provide an update on SDB and its treatment in HF-REF.
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Wu X, Fu C, Zhang S, Liu Z, Li S, Jiang L. Adaptive servoventilation improves cardiac dysfunction and prognosis in heart failure patients with sleep-disordered breathing: a meta-analysis. CLINICAL RESPIRATORY JOURNAL 2015; 11:547-557. [PMID: 26403758 DOI: 10.1111/crj.12390] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 08/24/2015] [Accepted: 09/24/2015] [Indexed: 01/16/2023]
Abstract
BACKGROUND Adaptive servoventilation (ASV) is a new therapeutic modality to treat sleep-disordered breathing (SDB) especially for central sleep apnoea associated with Cheyne-Stokes respiration, whereas the role of ASV in SDB patients with heart failure (HF) is controversial. The purpose of this study was to evaluate the effects of ASV on these patients through a meta-analysis of published data. METHODS A comprehensive literature search was performed to identify studies focused on ASV through databases, including PubMed, Medline, Embase, Cochrane Library and Web of science from 1950 to 2014. Parallel randomised controlled trials which compared ASV to other controls in HF and SDB patients with extractable data were meet our inclusion criteria. Random effects meta-analysis models were applied using RevMan 5.2. RESULTS Seven studies involving 301 patients were recruited in the meta-analysis. The weighted mean difference in apnoea hyponea index (-17.73 events/h, 95% CI, -21.85 to -2.94) and left ventricular ejection fraction (MD: 4.68, 95% CI, 2.74-6.63) both favored ASV compared to control conditions. The urinary noradrenaline level (MD: -32.18, 95%CI: -44.07 to -20.09) was decreased, while the exercise capacity measured by 6-min walk distance (MD: 41.26, 95% CI, 17.06-65.45) was improved after ASV treatment. Whereas neither left ventricular end-diastolic diameter (LVEDD) nor Epworth sleepiness-scale score (ESS) significantly changed after ASV therapy. CONCLUSIONS ASV is superior to other therapy, as it can result in good consequences for patients with SDB and improve their prognosis in cardiac function. Further studies will still be needed to assess the benefit of it.
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Affiliation(s)
- Xu Wu
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.,Clinical Center for Breathing Disorder and Snoring, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Cuiping Fu
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.,Clinical Center for Breathing Disorder and Snoring, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shuqi Zhang
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.,Clinical Center for Breathing Disorder and Snoring, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zilong Liu
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.,Clinical Center for Breathing Disorder and Snoring, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shanqun Li
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.,Clinical Center for Breathing Disorder and Snoring, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Liyan Jiang
- Department of Respiratory Medicine, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, China
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Spießhöfer J, Fox H, Lehmann R, Efken C, Heinrich J, Bitter T, Körber B, Horstkotte D, Oldenburg O. Heterogenous haemodynamic effects of adaptive servoventilation therapy in sleeping patients with heart failure and Cheyne-Stokes respiration compared to healthy volunteers. Heart Vessels 2015; 31:1117-30. [PMID: 26296413 DOI: 10.1007/s00380-015-0717-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 07/17/2015] [Indexed: 10/23/2022]
Abstract
This study investigated the haemodynamic effects of adaptive servoventilation (ASV) in heart failure (HF) patients with Cheyne-Stokes respiration (CSR) versus healthy controls. Twenty-seven HF patients with CSR and 15 volunteers were ventilated for 1 h using a new ASV device (PaceWave™). Haemodynamics were continuously and non-invasively recorded at baseline, during ASV and after ventilation. Prior to the actual study, a small validation study was performed to validate non-invasive measurement of Stroke volume index (SVI). Non-invasive measurement of SVI showed a marginal overall difference of -0.03 ± 0.41 L/min/m(2) compared to the current gold standard (Thermodilution-based measurement). Stroke volume index (SVI) increased during ASV in HF patients (29.7 ± 5 to 30.4 ± 6 to 28.7 ± 5 mL/m(2), p < 0.05) and decreased slightly in volunteers (50.7 ± 12 to 48.6 ± 11 to 47.9 ± 12 mL/m(2)). Simultaneously, 1 h of ASV was associated with a trend towards an increase in parasympathetic nervous activity (PNA) in HF patients and a trend towards an increase in sympathetic nervous activity (SNA) in healthy volunteers. Blood pressure (BP) and total peripheral resistance response increased significantly in both groups, despite marked inter-individual variation. Effects were independent of vigilance. Predictors of increased SVI during ASV in HF patients included preserved right ventricular function, normal resting BP, non-ischaemic HF aetiology, mitral regurgitation and increased left ventricular filling pressures. This study confirms favourable haemodynamic effects of ASV in HF patients with CSR presenting with mitral regurgitation and/or increased left ventricular filling pressures, but also identified a number of new predictors. This might be mediated by a shift towards more parasympathetic nervous activity in those patients.
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Affiliation(s)
- Jens Spießhöfer
- Department of Cardiology, Heart and Diabetes Centre North Rhine-Westphalia, University Hospital, Ruhr University Bochum, Georgstrasse 11, 32545, Bad Oeynhausen, Germany
| | - Henrik Fox
- Department of Cardiology, Heart and Diabetes Centre North Rhine-Westphalia, University Hospital, Ruhr University Bochum, Georgstrasse 11, 32545, Bad Oeynhausen, Germany
| | - Roman Lehmann
- Department of Cardiology, Heart and Diabetes Centre North Rhine-Westphalia, University Hospital, Ruhr University Bochum, Georgstrasse 11, 32545, Bad Oeynhausen, Germany
| | - Christina Efken
- Department of Cardiology, Heart and Diabetes Centre North Rhine-Westphalia, University Hospital, Ruhr University Bochum, Georgstrasse 11, 32545, Bad Oeynhausen, Germany
| | - Jessica Heinrich
- Department of Cardiology, Heart and Diabetes Centre North Rhine-Westphalia, University Hospital, Ruhr University Bochum, Georgstrasse 11, 32545, Bad Oeynhausen, Germany
| | - Thomas Bitter
- Department of Cardiology, Heart and Diabetes Centre North Rhine-Westphalia, University Hospital, Ruhr University Bochum, Georgstrasse 11, 32545, Bad Oeynhausen, Germany
| | - Britta Körber
- Department of Cardiology, Heart and Diabetes Centre North Rhine-Westphalia, University Hospital, Ruhr University Bochum, Georgstrasse 11, 32545, Bad Oeynhausen, Germany
| | - Dieter Horstkotte
- Department of Cardiology, Heart and Diabetes Centre North Rhine-Westphalia, University Hospital, Ruhr University Bochum, Georgstrasse 11, 32545, Bad Oeynhausen, Germany
| | - Olaf Oldenburg
- Department of Cardiology, Heart and Diabetes Centre North Rhine-Westphalia, University Hospital, Ruhr University Bochum, Georgstrasse 11, 32545, Bad Oeynhausen, Germany.
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Spießhöfer J, Heinrich J, Lehmann R, Efken C, Fox H, Bitter T, Körber B, Horstkotte D, Oldenburg O. Respiratory effects of adaptive servoventilation therapy in patients with heart failure and Cheyne-Stokes respiration compared to healthy volunteers. Respiration 2015; 89:374-82. [PMID: 25871423 DOI: 10.1159/000375312] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 12/30/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Nocturnal adaptive servoventilation (ASV) therapy is now frequently used to treat Cheyne-Stokes respiration (CSR), which is highly prevalent in patients with moderate-to-severe heart failure (HF) and characterized by periodical breathing (hyperventilation). OBJECTIVES This study analyzed and compared the acute effects of a novel ASV device on carbon dioxide pressure (pCO2) and oxygen saturation (SaO2) in HF patients with CSR and healthy volunteers. The influence of being asleep or awake on the ASV algorithm was also determined. METHODS All subjects underwent ASV (PaceWave™, ResMed) for 1 h. Transcutaneous pCO2 (PtcCO2) and SaO2 were assessed transcutaneously, while wakefulness was analyzed using EEG recordings. Assessments were made 30 min before and after ASV, and during 1 h of ASV. RESULTS Twenty HF patients (19 male; age 79 ± 12 years) and 15 volunteers (13 male, age 25 ± 4 years) were included. When awake, ASV was associated with a trend towards a decrease in PtcCO2 and an increase in SaO2 versus baseline in HF patients (34.4 ± 3.2 to 33.7 ± 3.8 mm Hg and 93.8 ± 2.6 to 94.9 ± 2.6%, respectively) and volunteers (39.5 ± 3.0 to 38.2 ± 3.8 mm Hg and 96.9 ± 1.3 to 97.8 ± 0.9%). While asleep during ASV, PtcCO2 increased to 36.3 ± 3.8 mm Hg and SaO2 decreased to 93.8 ± 2.6% in HF patients, with similar changes in volunteers (PtcCO2 41.7 ± 3.0 mm Hg, SaO2 97.1 ± 1.2). All comparisons were statistically significant (p ≤ 0.05, except the PtcCO2 decrease in both groups when awake). CONCLUSIONS ASV therapy might result in hyperventilation when subjects are awake, but while asleep, PtcCO2 increased to mid-normal values, effects that would be favorable in HF patients with CSR.
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Affiliation(s)
- Jens Spießhöfer
- Department of Cardiology, Heart and Diabetes Centre North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany
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Cowie MR, Woehrle H, Oldenburg O, Damy T, van der Meer P, Erdman E, Metra M, Zannad F, Trochu JN, Gullestad L, Fu M, Böhm M, Auricchio A, Levy P. Sleep-disordered Breathing in Heart Failure - Current State of the Art. Card Fail Rev 2015; 1:16-24. [PMID: 28785426 PMCID: PMC5491026 DOI: 10.15420/cfr.2015.01.01.16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 02/07/2015] [Indexed: 11/04/2022] Open
Abstract
Sleep-disordered breathing (SDB), either obstructive sleep apnoea (OSA) or central sleep apnoea (CSA)/Cheyne-Stokes respiration (CSR) and often a combination of the two, is highly prevalent in patients with heart failure (HF), is associated with reduced functional capacity and quality of life, and has a negative prognostic impact. European HF guidelines identify that sleep apnoea is of concern in patients with HF. Continuous positive airway pressure is the treatment of choice for OSA, and adaptive servoventilation (ASV) appears to be the most consistently effective therapy for CSA/CSR while also being able to treat concomitant obstructive events. There is a growing body of evidence that treating SDB in patients with HF, particularly using ASV for CSA/CSR, improves functional outcomes such as HF symptoms, cardiac function, cardiac disease markers, exercise tolerance and quality of life. However, conflicting results have been reported on 'hard' outcomes such as mortality and healthcare utilisation, and the influence of effectively treating SDB, including CSA/CSR, remains to be determined in randomised clinical trials. Two such trials (SERVE-HF and ADVENT-HF) in chronic stable HF and another in post-acute decompensated HF (CAT-HF) are currently underway.
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Affiliation(s)
| | - Holger Woehrle
- Imperial College London, London, UK;
- ResMed Science Centre, ResMed Europe, Munich, Germany;
| | - Olaf Oldenburg
- Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany;
| | | | - Peter van der Meer
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands;
| | | | | | | | | | | | - Michael Fu
- Sahlgrenska University Hospital/östra Hospital, Göteborg, Sweden;
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