Abstract
Background: 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 ...
Abstract
Background: 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. Methods: 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 H(2)O above the EPAP. Results: CPAP or BPAP significantly reduced the apnea-hypopnea index (AM) [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 cur H(2)O; maximal IPAP, 21.9 +/- 2.1 ern H(2)O) 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). Conclusion: Flow-targeted dynamic BPAP support effectively suppresses CSR-CSA in patients with CHF and is well tolerated.
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