Andrea Hetzenecker1, Pierre Escourrou2, Samuel T Kuna3, Frederic Series4, Keir Lewis5, Christoph Birner6, Michael Pfeifer7, Michael Arzt8. 1. Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany; Center for Pneumology, Donaustauf Hospital, Donaustauf, Germany. 2. Centre de Médecine du Sommeil, Hopital Antoine Beclere, Clamart, France. 3. Department of Medicine, Perleman School of Medicine, University of Pennsylvania, USA; Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, USA. 4. Centre de Recherche, IUCPQ, Universite Laval, Quebec, Canada. 5. Department of Respiratory Medicine, Prince Philip Hospital and Swansea College of Medicine, Wales, UK. 6. Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany. 7. Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany; Center for Pneumology, Donaustauf Hospital, Donaustauf, Germany; Clinic for Pulmonology, Hospital of the Order of St. John of God Regensburg, Germany. 8. Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany. Electronic address: michael.arzt@ukr.de.
Abstract
BACKGROUND:Impaired sleep efficiency is independently associated with worse prognosis in patients with chronic heart failure (CHF). Therefore, a test was conducted on whether auto-servo ventilation (ASV, biphasic positive airway pressure [BiPAP]-ASV, Philips Respironics) reduces sleep fragmentation and improves sleep efficiency in CHF patients with central sleep apnea (CSA) or obstructive sleep apnea (OSA). METHODS: In this multicenter, randomized, parallel group trial, a study was conducted on 63 CHF patients (age 64 ± 10 years; left ventricular ejection fraction 29 ± 7%) with CSA or OSA (apnea-hypopnea Index, AHI 47 ± 18/h; 46% CSA) referred to sleep laboratories of the four participating centers. Participants were randomized to either ASV (n = 32) or optimal medical treatment alone (control, n = 31). RESULTS: Polysomnography (PSG) and actigraphy at home (home) with centralized blinded scoring were obtained at baseline and 12 weeks. ASV significantly reduced sleep fragmentation (total arousalindexPSG: -16.4 ± 20.6 vs. -0.6 ± 13.2/h, p = 0.001; sleep fragmentation indexhome: -7.6 ± 15.6 versus 4.3 ± 13.9/h, p = 0.003, respectively) and significantly increased sleep efficiency assessed by actigraphy (SEhome) compared to controls (2.3 ± 10.1 vs. -2.1 ± 6.9%, p = 0.002). Effects of ASV on sleep fragmentation and efficiency were similar in patients suffering from OSA and CSA. CONCLUSIONS: At home, ASV treatment modestly improves sleep fragmentation as well as sleep efficiency in CHF patients having either CSA or OSA.
RCT Entities:
BACKGROUND: Impaired sleep efficiency is independently associated with worse prognosis in patients with chronic heart failure (CHF). Therefore, a test was conducted on whether auto-servo ventilation (ASV, biphasic positive airway pressure [BiPAP]-ASV, Philips Respironics) reduces sleep fragmentation and improves sleep efficiency in CHFpatients with central sleep apnea (CSA) or obstructive sleep apnea (OSA). METHODS: In this multicenter, randomized, parallel group trial, a study was conducted on 63 CHFpatients (age 64 ± 10 years; left ventricular ejection fraction 29 ± 7%) with CSA or OSA (apnea-hypopnea Index, AHI 47 ± 18/h; 46% CSA) referred to sleep laboratories of the four participating centers. Participants were randomized to either ASV (n = 32) or optimal medical treatment alone (control, n = 31). RESULTS: Polysomnography (PSG) and actigraphy at home (home) with centralized blinded scoring were obtained at baseline and 12 weeks. ASV significantly reduced sleep fragmentation (total arousal indexPSG: -16.4 ± 20.6 vs. -0.6 ± 13.2/h, p = 0.001; sleep fragmentation indexhome: -7.6 ± 15.6 versus 4.3 ± 13.9/h, p = 0.003, respectively) and significantly increased sleep efficiency assessed by actigraphy (SEhome) compared to controls (2.3 ± 10.1 vs. -2.1 ± 6.9%, p = 0.002). Effects of ASV on sleep fragmentation and efficiency were similar in patients suffering from OSA and CSA. CONCLUSIONS: At home, ASV treatment modestly improves sleep fragmentation as well as sleep efficiency in CHFpatients having either CSA or OSA.
Authors: Katharina Heider; Michael Arzt; Christoph Lerzer; Leonie Kolb; Michael Pfeifer; Lars S Maier; Florian Gfüllner; Maximilian Valentin Malfertheiner Journal: Clin Res Cardiol Date: 2018-01-25 Impact factor: 5.460
Authors: Leonie Kolb; Michael Arzt; Stefan Stadler; Katharina Heider; Lars S Maier; Maximilian Malfertheiner Journal: Sleep Breath Date: 2020-09-03 Impact factor: 2.816