BACKGROUND: Cheyne-Stokes respiration with central sleep apnea (CSR-CSA) is associated with a poor prognosis in patients with heart failure (HF). However, some patients do not respond to continuous positive airway pressure (CPAP), so other therapeutic modalities should be considered, such as bi-level positive airway pressure (PAP), which also assists respiration and might be effective for such patients. METHODS AND RESULTS: The 20 patients with HF because of left ventricular systolic dysfunction were assessed: 8 had ischemic etiology, and all had severe CSA according to the apnea - hypopnea index (AHI) determined by polysomnography. All diagnosed patients underwent repeat polysomnography using CPAP. The AHI improved significantly in 11 (AHI <15), but only slightly in 9, in whom the AHI remained high (>or=15). Bi-level PAP titration significantly improved the AHI in the latter group. Those who were unresponsive to CPAP had significantly lower PaCO(2), higher plasma brain natriuretic peptide (BNP), longer mean duration of CSR and fewer obstructive episodes than CPAP responders. After 6 months of positive airway support with either CPAP (n=9) or bi-level PAP (n=7), BNP levels significantly decreased and left ventricular ejection fraction significantly increased. CONCLUSIONS: Bi-level PAP could be an effective alternative for patients with HF and pure CSR-CSA who are unresponsive to CPAP.
BACKGROUND: Cheyne-Stokes respiration with central sleep apnea (CSR-CSA) is associated with a poor prognosis in patients with heart failure (HF). However, some patients do not respond to continuous positive airway pressure (CPAP), so other therapeutic modalities should be considered, such as bi-level positive airway pressure (PAP), which also assists respiration and might be effective for such patients. METHODS AND RESULTS: The 20 patients with HF because of left ventricular systolic dysfunction were assessed: 8 had ischemic etiology, and all had severe CSA according to the apnea - hypopnea index (AHI) determined by polysomnography. All diagnosed patients underwent repeat polysomnography using CPAP. The AHI improved significantly in 11 (AHI <15), but only slightly in 9, in whom the AHI remained high (>or=15). Bi-level PAP titration significantly improved the AHI in the latter group. Those who were unresponsive to CPAP had significantly lower PaCO(2), higher plasma brain natriuretic peptide (BNP), longer mean duration of CSR and fewer obstructive episodes than CPAP responders. After 6 months of positive airway support with either CPAP (n=9) or bi-level PAP (n=7), BNP levels significantly decreased and left ventricular ejection fraction significantly increased. CONCLUSIONS: Bi-level PAP could be an effective alternative for patients with HF and pure CSR-CSA who are unresponsive to CPAP.
Authors: R Nisha Aurora; Susmita Chowdhuri; Kannan Ramar; Sabin R Bista; Kenneth R Casey; Carin I Lamm; David A Kristo; Jorge M Mallea; James A Rowley; Rochelle S Zak; Sharon L Tracy Journal: Sleep Date: 2012-01-01 Impact factor: 5.849
Authors: Martin R Cowie; Holger Woehrle; Olaf Oldenburg; Thibaud Damy; Peter van der Meer; Erland Erdman; Marco Metra; Faiez Zannad; Jean-Noel Trochu; Lars Gullestad; Michael Fu; Michael Böhm; Angelo Auricchio; Patrick Levy Journal: Card Fail Rev Date: 2015-04
Authors: David Slouka; Monika Honnerova; Petr Hosek; Bretislav Gal; Ondrej Trcka; Tomas Kostlivy; Jana Landsmanova; David Havel; Martina Baneckova; Radek Kucera Journal: J Appl Biomed Date: 2019-01-10 Impact factor: 1.797