Treatment with continuous positive airway pressure (CPAP) improves cardiac function in chronic heart failure (CHF) patients with central sleep apnea (CSA)-Cheyne-Stokes respiration (CSR) by stabilizing ventilation, but frequently central apneas and hypopneas persist. Our objective was to test the hypothesis that flow-targeted dynamic bilevel positive airway pressure (BPAP) support (BiPAP autoSV; Respironics; Murrysville, PA) effectively suppresses CSR-CSA in CHF patients.
We studied 14 CHF patients with CSR-CSA (and residual CSA on positive airway pressure therapy) during 3 consecutive nights: (1) diagnostic polysomnography, (2) CPAP (n=10) or BPAP (n=4) titration, and (3) dynamic flow-targeted dynamic BPAP support with an expiratory positive airway pressure (EPAP) set to suppress obstructive respiratory events, and an inspiratory positive airway pressure (IPAP) dynamically ranging between 0 and 15 cm H2O above the EPAP.
CPAP or BPAP significantly reduced the apnea-hypopnea index (AHI) [mean+/-SD, 46+/-4 events/h to 22+/-4 events/h; p=0.001] compared to the first night without treatment. Flow-targeted dynamic BPAP support (mean EPAP, 6.5+/-1.7 cm H2O; maximal IPAP, 21.9+/-2.1 cm H2O) further reduced the AHI to 4+/-1/h of sleep compared to the untreated (p<0.001) and CPAP or BPAP night (p=0.002). After the first night of flow-targeted dynamic BPAP support, patients rated on an analog scale (range, 0 to 10) the treatment as comfortable (6.9+/-0.6), and the sleep quality as improved compared to previous nights (7.4+/-0.6).
Flow-targeted dynamic BPAP support effectively suppresses CSR-CSA in patients with CHF and is well tolerated.
"In the up-to-date version of flow-targeted devices, the expiratory pressure is also adjusted automatically , with data showing a slightly better suppression of respiratory disturbances as compared with the algorithm with fixed expiratory positive airway pressure (EPAP). Since its introduction in 2001, many case series, case control series, and randomized controlled trials (RCT) have been published with considerable improvement in AHI, left ventricular ejection fraction (LVEF), and quality of life with volume-targeted           and flow-targeted devices       in patients with pure CSR. It was found that even patients with mild to moderate sleep disordered breathing (SDB) can demonstrate a significant improvement in LVEF  . "
"Eight weeks was probably too short to show improvement in LV function for both treatment modalities. Another type of ASV (auto servo-ventilation) also effectively treats CSR-CSA . Kasai et al. reported the results of randomized study, J-ASV, of this device in comparison with CPAP in patients with chronic heart failure and coexisting CSR-CSA and OSA . "
[Show abstract][Hide abstract] ABSTRACT: Sleep disordered breathing including obstructive sleep apnea (OSA) and central sleep apnea (CSA) with Cheyne-Stokes respiration (CSR) is often accompanied by heart failure. Treatment of OSA centered on continuous positive airway pressure (CPAP) is established. However, treatment of CSR-CSA is still controversial. Since CSR-CSA occurs as a consequence of heart failure, optimization of heart failure is essential to treat CSR-CSA. For treatment directed at CSR-CSA itself, a variety of treatment approaches including night oxygen therapy and noninvasive positive pressure ventilation have been applied. Among them, night oxygen therapy improves patients' symptoms, quality of life (QOL), and left ventricular function, but had yet been shown to improve clinical outcome. For CPAP, there are responders and non-responders and for responders CPAP can also improve survival. Adaptive servo-ventilation (ASV), which most effectively treats CSR-CSA, improves exercise capacity, QOL, and cardiac function. Recent reports suggested ASV may also prevent cardiac events in patients with heart failure. However, further studies are needed to conclude that this treatment improves patient survival.
Journal of Cardiology 03/2012; 59(2):110-6. DOI:10.1016/j.jjcc.2011.12.008 · 2.78 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We presented and discussed the design and characterisation of a
fully integrated CMOS-VCSEL transmitter array. A new circuit concept for
current peaking is used. The realized transmitter shows negligibly small
cross talk and operates up to 2.5 Gbit/s per channel. These results
indicate that the introduced circuit concept allows the implementation
of driver arrays with a dense channel grid for a VCSEL based OE-VLSI
Lasers and Electro-Optics Society, 2001. LEOS 2001. The 14th Annual Meeting of the IEEE; 02/2001
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