Abstract

AbstractRationale:The coexistence of Obstructive (OSA) and Central Sleep Apnea (CSA) and Cheyne-Stokes Respiration (CSR) is common in patients with Heart Failure (HF). While Continuous Positive Airway Pressure (CPAP) improves CSA/CSR by about 50%, maximal suppression is crucial in improving clinical outcomes. Auto Servo-Ventilation (ASV) effectively suppresses CSA/CSR in HF, but few trials have been performed in patients with co-existing OSA and CSA/CSR.

OBJECTIVES:

Randomized, controlled trial to compare the efficacy of ASV and CPAP in reducing breathing disturbances and improving cardiac parameters in patients with HF and co-existing sleep-disordered breathing.

METHODS:

Both modes were delivered using the BiPAP autoSV®, Respironics, USA over a twelve month period. 70 patients (63 male, 66.3±9.1 y., BMI 31.3±6.0 kg/m(2)) had co-existing OSA and CSA/CSR, arterial hypertension, coronary heart disease or cardiomyopathy and clinical signs of heart failure NYHA II-III. Polysomnography, brain natriuretic peptide, spiroergometry and echocardiography were performed at baseline, after 3 and 12 months of treatment.Measurements and Main

RESULTS:

Both modes of therapy significantly improved respiratory disturbances, oxygen desaturations and arousals over the study period. ASV reduced the central AHI (Baseline CPAP 21.8±11.7, ASV 23.1±13.2, 12 months CPAP 10.7±8.7, ASV 6.1±7.8, p<0.05) and BNP levels (Baseline CPAP 686.7±978.7ng/ml, ASV 537.3±891.8, 12 months CPAP 847.3±1848.1, ASV 230.4±297.4, p<0.05) significantly more effectively as compared to CPAP. There were no relevant differences in exercise performance and echocardiographic parameters between the groups.

CONCLUSIONS:

ASV improved CSA/CSR and brain natriuretic peptide over a 12 month period more effectively than CPAP.