Effects of Dynamic Bilevel Positive Airway Pressure Support on Central Sleep Apnea in Men With Heart Failure*

Department of Internal Medicine II, University of Regensburg, Franz-Josef-Straubeta-Allee 11, 93042 Regensburg, Germany.
Chest (Impact Factor: 7.48). 07/2008; 134(1):61-6. DOI: 10.1378/chest.07-1620
Source: PubMed


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.

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    • "In the up-to-date version of flow-targeted devices, the expiratory pressure is also adjusted automatically [3], 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 [4] [5] [6] [7] [8] [9] [10] [11] [12] [13] and flow-targeted devices [14] [15] [16] [17] [18] [19] 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 [12] [13]. "
    Sleep Medicine 08/2014; 15(8). DOI:10.1016/j.sleep.2014.04.006 · 3.15 Impact Factor
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    • "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 [42]. 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 [43]. "
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    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.
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