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Acute haemodynamic effects of continuous positive airway pressure in awake patients with heart failure
Author(s) -
Schroll Stephan,
Sériès Frédéric,
Lewis Keir,
Benjamin Amit,
Escourrou Pierre,
Luigart Ruth,
Pfeifer Michael,
Arzt Michael
Publication year - 2014
Publication title -
respirology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.857
H-Index - 85
eISSN - 1440-1843
pISSN - 1323-7799
DOI - 10.1111/resp.12193
Subject(s) - medicine , continuous positive airway pressure , atrial fibrillation , cardiology , heart failure , hemodynamics , heart rate , sinus rhythm , anesthesia , blood pressure , positive airway pressure , cardiac output , obstructive sleep apnea
Background and objective Continuous positive airway pressure ( CPAP ) has been used to treat patients with chronic heart failure ( CHF ) and sleep‐disordered breathing ( SDB ). CPAP treatment in severe CHF with concomitant SDB and atrial fibrillation has been linked to impairment of cardiac output ( CO ) as a potential cause for adverse outcome. The aim of the present study was to test whether incremental CPAP application in awake CHF patients with SDB , with and without atrial fibrillation, induces acute alterations of blood pressure ( BP ), heart rate ( HR ) and CO . Methods During daytime, we applied incremental CPAP (4–10 cm H 2 O ) in 37 stable patients with CHF and SDB . BP and HR were assessed after each 1 cm H 2 O CPAP increase in 5‐min intervals in the entire sample, and CO was assessed at one centre ( n = 11). Results Neither mean BP , HR nor CO changed significantly with incremental CPAP (at 0 and 10 cm H 2 O : 85 ± 2 and 84 ± 2 mm H g, P = 1.0, 63 ± 1 to 61 ± 2 b.p.m., P = 0.88 and 2.03 ± 0.5 and 2.35 ± 0.8 L/min/m 2 , P = 0.92, respectively). No significant differences in maximum BP drop or HR drop between patients with sinus rhythm and atrial fibrillation were found. In 1 of 37 patients, a prespecified event of haemodynamic compromise (drop of mean BP >15 mm Hg) without clinical signs occurred. Conclusions These results contribute to the evidence that CPAP does not cause haemodynamic compromise in the vast majority of normotensive CHF patients with SDB .