Martha Gorbachevski1, Jens Spiesshoefer2, Michael Arzt3, Olaf Oldenburg4, Sara Becker1, Izabela Tuleta5, Michele Emdin6, Claudio Passino6, Paolo Sciarrone7, Matthias Boentert8, Alberto Giannoni6. 1. Department of Neurology with Institute for Translational Neurology, University Hospital Muenster, Muenster, Germany. 2. Department of Neurology with Institute for Translational Neurology, University Hospital Muenster, Muenster, Germany; Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy. Electronic address: jens.spiesshoefer@ukmuenster.de. 3. Department of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany. 4. Ludgerus-Kliniken Münster, Clemenshospital, Münster, Germany. 5. Department of Cardiology I, University Hospital of Muenster, Muenster, Germany. 6. Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy; Cardiology and Cardiovascular Medicine Division, Fondazione Toscana Gabriele Monasterio, National Research Council, CNR-Regione Toscana, Pisa, Italy. 7. Cardiology and Cardiovascular Medicine Division, Fondazione Toscana Gabriele Monasterio, National Research Council, CNR-Regione Toscana, Pisa, Italy. 8. Department of Neurology with Institute for Translational Neurology, University Hospital Muenster, Muenster, Germany; Department of Medicine, UKM Marienhospital Steinfurt, Steinfurt, Germany.
Abstract
BACKGROUND: In contrast to continuous positive airway pressure (CPAP), the use of adaptive servo-ventilation (ASV) for treatment of central sleep apnoea (CSA) was associated with increased mortality in patients with chronic systolic heart failure (CHF). In order to characterize the interplay between sleep-disordered breathing, CHF and sympathovagal balance (SVB) this study investigated the effect of nocturnal CPAP and ASV on SVB in CSA patients with or without CHF. METHODS: Thirty-seven patients with ongoing positive airway pressure therapy (CPAP or ASV) for CSA (17 patients with systolic CHF - left ventricular ejection fraction <50% - and 20 patients with CSA but no CHF) underwent evaluation of SVB (spectral analysis of heart rate -HRV- and diastolic blood pressure variability) during full nocturnal polysomnography. The night was randomly split into equal parts including no treatment (NT), automatic CPAP and ASV. Data analysis was restricted to stable N2 sleep. RESULTS: In patients with CSA and systolic CHF, neither automatic CPAP nor ASV showed favourable effects on parameters reflecting SVB during N2 sleep (all p > 0.05). In contrast, in subjects with CSA without CHF automatic CPAP, but not ASV, favourably altered SVB by decreasing the low frequency and increasing the high frequency component of HRV (both p = 0.03). CONCLUSIONS: Effects of various modes of positive airway pressure therapy of CSA on SVB during sleep depend on the mode of pressure support and underlying cardiac function. Automatic CPAP but not ASV favourably influences SVB in subjects without CHF, whereas both interventions leave SVB unchanged in patients with CHF.
BACKGROUND: In contrast to continuous positive airway pressure (CPAP), the use of adaptive servo-ventilation (ASV) for treatment of central sleep apnoea (CSA) was associated with increased mortality in patients with chronic systolic heart failure (CHF). In order to characterize the interplay between sleep-disordered breathing, CHF and sympathovagal balance (SVB) this study investigated the effect of nocturnal CPAP and ASV on SVB in CSA patients with or without CHF. METHODS: Thirty-seven patients with ongoing positive airway pressure therapy (CPAP or ASV) for CSA (17 patients with systolic CHF - left ventricular ejection fraction <50% - and 20 patients with CSA but no CHF) underwent evaluation of SVB (spectral analysis of heart rate -HRV- and diastolic blood pressure variability) during full nocturnal polysomnography. The night was randomly split into equal parts including no treatment (NT), automatic CPAP and ASV. Data analysis was restricted to stable N2 sleep. RESULTS: In patients with CSA and systolic CHF, neither automatic CPAP nor ASV showed favourable effects on parameters reflecting SVB during N2 sleep (all p > 0.05). In contrast, in subjects with CSA without CHF automatic CPAP, but not ASV, favourably altered SVB by decreasing the low frequency and increasing the high frequency component of HRV (both p = 0.03). CONCLUSIONS: Effects of various modes of positive airway pressure therapy of CSA on SVB during sleep depend on the mode of pressure support and underlying cardiac function. Automatic CPAP but not ASV favourably influences SVB in subjects without CHF, whereas both interventions leave SVB unchanged in patients with CHF.
Authors: Olaf Oldenburg; Maria Rosa Costanzo; Robin Germany; Scott McKane; Timothy E Meyer; Henrik Fox Journal: J Cardiovasc Transl Res Date: 2020-08-12 Impact factor: 4.132