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Effect of flow-triggered adaptive servo-ventilation compared with continuous positive airway pressure in patients with chronic heart failure with coexisting obstructive sleep apnea and Cheyne-Stokes respiration.
Circ Heart Fail. 2010 Jan; 3(1):140-8.CH

Abstract

BACKGROUND

In patients with chronic heart failure (CHF), the presence of sleep-disordered breathing, including either obstructive sleep apnea or Cheyne-Stokes respiration-central sleep apnea, is associated with a poor prognosis. A large-scale clinical trial showed that continuous positive airway pressure (CPAP) did not improve the prognosis of such patients with CHF, probably because of insufficient sleep-disordered breathing suppression. Recently, it was reported that adaptive servo-ventilation (ASV) can effectively treat sleep-disordered breathing. However, there are no specific data about the efficacy of flow-triggered ASV for cardiac function in patients with CHF with sleep-disordered breathing. The aim of this study was to compare the efficacy of flow-triggered ASV to CPAP in patients with CHF with coexisting obstructive sleep apnea and Cheyne-Stokes respiration-central sleep apnea.

METHODS AND RESULTS

Thirty-one patients with CHF, defined as left ventricular ejection fraction <50% and New York Heart Association class >or=II, with coexisting obstructive sleep apnea and Cheyne-Stokes respiration-central sleep apnea, were randomly assigned to either CPAP or flow-triggered ASV. The suppression of respiratory events, changes in cardiac function, and compliance with the devices during the 3-month study period were compared. Although both devices decreased respiratory events, ASV more effectively suppressed respiratory events (DeltaAHI [apnea-hypopnea index], -35.4+/-19.5 with ASV; -23.2+/-12.0 with CPAP, P<0.05). Compliance was significantly greater with ASV than with CPAP (5.2+/-0.9 versus 4.4+/-1.1 h/night, P<0.05). The improvements in quality-of-life and left ventricular ejection fraction were greater in the ASV group (DeltaLVEF [left ventricular ejection fraction], +9.1+/-4.7% versus +1.9+/-10.9%).

CONCLUSIONS

These results suggest that patients with coexisting obstructive sleep apnea and Cheyne-Stokes respiration-central sleep apnea may receive greater benefit from treatment with ASV than with CPAP.

Authors+Show Affiliations

Sleep Center, Toranomon Hospital, Tokyo, Japan. kasai-t@mx6.nisiq.netNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

19933407

Citation

Kasai, Takatoshi, et al. "Effect of Flow-triggered Adaptive Servo-ventilation Compared With Continuous Positive Airway Pressure in Patients With Chronic Heart Failure With Coexisting Obstructive Sleep Apnea and Cheyne-Stokes Respiration." Circulation. Heart Failure, vol. 3, no. 1, 2010, pp. 140-8.
Kasai T, Usui Y, Yoshioka T, et al. Effect of flow-triggered adaptive servo-ventilation compared with continuous positive airway pressure in patients with chronic heart failure with coexisting obstructive sleep apnea and Cheyne-Stokes respiration. Circ Heart Fail. 2010;3(1):140-8.
Kasai, T., Usui, Y., Yoshioka, T., Yanagisawa, N., Takata, Y., Narui, K., Yamaguchi, T., Yamashina, A., & Momomura, S. I. (2010). Effect of flow-triggered adaptive servo-ventilation compared with continuous positive airway pressure in patients with chronic heart failure with coexisting obstructive sleep apnea and Cheyne-Stokes respiration. Circulation. Heart Failure, 3(1), 140-8. https://doi.org/10.1161/CIRCHEARTFAILURE.109.868786
Kasai T, et al. Effect of Flow-triggered Adaptive Servo-ventilation Compared With Continuous Positive Airway Pressure in Patients With Chronic Heart Failure With Coexisting Obstructive Sleep Apnea and Cheyne-Stokes Respiration. Circ Heart Fail. 2010;3(1):140-8. PubMed PMID: 19933407.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effect of flow-triggered adaptive servo-ventilation compared with continuous positive airway pressure in patients with chronic heart failure with coexisting obstructive sleep apnea and Cheyne-Stokes respiration. AU - Kasai,Takatoshi, AU - Usui,Yasuhiro, AU - Yoshioka,Toru, AU - Yanagisawa,Naotake, AU - Takata,Yoshifumi, AU - Narui,Koji, AU - Yamaguchi,Tetsu, AU - Yamashina,Akira, AU - Momomura,Shin-ich, AU - ,, Y1 - 2009/11/20/ PY - 2009/11/26/entrez PY - 2009/11/26/pubmed PY - 2010/2/17/medline SP - 140 EP - 8 JF - Circulation. Heart failure JO - Circ Heart Fail VL - 3 IS - 1 N2 - BACKGROUND: In patients with chronic heart failure (CHF), the presence of sleep-disordered breathing, including either obstructive sleep apnea or Cheyne-Stokes respiration-central sleep apnea, is associated with a poor prognosis. A large-scale clinical trial showed that continuous positive airway pressure (CPAP) did not improve the prognosis of such patients with CHF, probably because of insufficient sleep-disordered breathing suppression. Recently, it was reported that adaptive servo-ventilation (ASV) can effectively treat sleep-disordered breathing. However, there are no specific data about the efficacy of flow-triggered ASV for cardiac function in patients with CHF with sleep-disordered breathing. The aim of this study was to compare the efficacy of flow-triggered ASV to CPAP in patients with CHF with coexisting obstructive sleep apnea and Cheyne-Stokes respiration-central sleep apnea. METHODS AND RESULTS: Thirty-one patients with CHF, defined as left ventricular ejection fraction <50% and New York Heart Association class >or=II, with coexisting obstructive sleep apnea and Cheyne-Stokes respiration-central sleep apnea, were randomly assigned to either CPAP or flow-triggered ASV. The suppression of respiratory events, changes in cardiac function, and compliance with the devices during the 3-month study period were compared. Although both devices decreased respiratory events, ASV more effectively suppressed respiratory events (DeltaAHI [apnea-hypopnea index], -35.4+/-19.5 with ASV; -23.2+/-12.0 with CPAP, P<0.05). Compliance was significantly greater with ASV than with CPAP (5.2+/-0.9 versus 4.4+/-1.1 h/night, P<0.05). The improvements in quality-of-life and left ventricular ejection fraction were greater in the ASV group (DeltaLVEF [left ventricular ejection fraction], +9.1+/-4.7% versus +1.9+/-10.9%). CONCLUSIONS: These results suggest that patients with coexisting obstructive sleep apnea and Cheyne-Stokes respiration-central sleep apnea may receive greater benefit from treatment with ASV than with CPAP. SN - 1941-3297 UR - https://www.unboundmedicine.com/medline/citation/19933407/Effect_of_flow_triggered_adaptive_servo_ventilation_compared_with_continuous_positive_airway_pressure_in_patients_with_chronic_heart_failure_with_coexisting_obstructive_sleep_apnea_and_Cheyne_Stokes_respiration_ L2 - https://www.ahajournals.org/doi/10.1161/CIRCHEARTFAILURE.109.868786?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -