Premium
Effect of oxygen versus adaptive pressure support servo‐ventilation in patients with central sleep apnoea–Cheyne S tokes respiration and congestive heart failure
Author(s) -
Campbell A. J.,
Ferrier K.,
Neill A. M.
Publication year - 2012
Publication title -
internal medicine journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.596
H-Index - 70
eISSN - 1445-5994
pISSN - 1444-0903
DOI - 10.1111/j.1445-5994.2011.02623.x
Subject(s) - medicine , cheyne–stokes respiration , heart failure , ejection fraction , cardiology , polysomnography , ventilation (architecture) , anesthesia , apnea , mechanical engineering , engineering
Background and Aims Central sleep apnoea with C heyne‐ S tokes respiration ( CSA‐CSR ) is a common, serious consequence of congestive heart failure. Optimal treatment is yet to be established. We compared two common treatments for CSA‐CSR . Methods Subjects with CSA‐CSR and stable congestive heart failure were randomised to 8 weeks treatment: oxygen 2 L /min through nasal prongs and concentrator or 8 weeks adaptive servo‐ventilation ( ASV ) using a crossover design separated by a 3‐week washout. Polysomnography, indices of sleep and breathing, shuttle walk distance, symptoms, urinary catecholamines, plasma brain natriuretic peptide ( NT‐BNP ) and echocardiography were collected at baseline and completion of each arm. Results Ten subjects (age 64 ± 10 years, left ventricular ejection fraction ( LVEF ) 28 ± 10.5%, apnoea‐hypopnoea index ( AHI ) 63 ± 30/h) were recruited. Seven completed the protocol (one died, one refused ASV , one was withdrawn after hospital admission). On therapy, an AHI of < 10/h was achieved in two out of seven using oxygen (29%), six of seven using ASV (86%) and six of seven with either (86%). Compliance with ASV : 5.2 ± 2 h/night (range 1.45–7.1 h/night). Median AHI on oxygen therapy: 13.4 /h (range 2.6–42.9/h), ASV , 1.4 /h (range 0.6–17.8/h, P = 0.03). LVEF was not changed by either therapy (oxygen 30.9% vs 30.9% P = 0.97, ASV 32.5% vs 35.0% P = 0.24). NT‐BNP , urinary catecholamines, shuttle walk distance and symptoms were not significantly changed by either therapy. Conclusion CSA‐CSR is reduced to a greater extent by ASV than oxygen therapy over 8 weeks but was not accepted long term. Neither treatment improved prognostic indices of heart failure or symptoms in the short term.