Efficacy of nasal bi-level positive airway pressure in congestive heart failure patients with cheyne-stokes respiration and central sleep apnea

Positive pressure ventilation treatment reduces plasma levels of amino terminal-pro brain natriuretic peptide in congestive heart failure patients with sleep apnea

BACKGROUND

The purpose of the present study was to assess the short-term effects of positive pressure ventilation (PPV) on plasma amino terminal-pro brain natriuretic peptide (NT-proBNP) levels in patients with congestive heart failure (CHF) and sleep apnea (SA).

METHODS AND RESULTS

Polysomnography was performed in 105 CHF patients. Twenty-six patients with CHF and SA were randomly assigned to a control group or a PPV group. Patients in the higher New York Heart Association classes had higher plasma levels of NT-proBNP. The plasma NT-proBNP concentration in the PPV group decreased.

CONCLUSION

Plasma NT-proBNP levels reflect the severity of CHF, and PPV can decrease plasma NT-proBNP levels in patients with CHF and SA.

Oxygen Therapy Prevents Ventricular Arrhythmias in Patients With Congestive Heart Failure and Sleep Apnea

BACKGROUND

Although ventricular arrhythmia is critical for the prognosis of patients with severe congestive heart failure (CHF), it is difficult to control the arrhythmia using conservative therapies. However, many CHF patients also have sleep apnea syndrome (SAS) and oxygen supply improves their prognosis. The beneficial effects of oxygen treatment for ventricular arrhythmia have not yet been clarified, so the present study was designed to evaluate the effects of oxygen treatment for premature ventricular contraction (PVC).

METHODS AND RESULTS

Patients with CHF and SAS were divided into 3 groups: (1) the "PVC declined" group that included patients who had frequent PVCs and oxygen treatment that suppressed the number of PVC; (2) the "PVC not affected" group that included patients who had frequent PVCs and oxygen treatment did not affect the number of PVC; and (3) the "few PVC" group that included patients who had no or few PVCs. The group 1 patients showed higher apnea-hypopnea index, standard deviation of all R-R intervals, left ventricular ejection fraction, and brain natriuretic peptide levels than the patients in group 2. Oxygen treatment in group 3 did not affect the PVC frequency.

CONCLUSIONS

Oxygen treatment may be useful for preventing ventricular arrhythmia in selected patients with CHF and SAS.

First Experience of Using New Adaptive Servo-Ventilation Device for Cheyne-Stokes Respiration With Central Sleep Apnea Among Japanese Patients With Congestive Heart Failure Report of 4 Clinical Cases

BACKGROUND

Cheyne-Stokes respiration with central sleep apnea (CSR-CSA) in congestive heart failure (CHF) is generally considered a poor prognostic indicator, but treatment of CSR-CSA using an adaptive servo-ventilation (ASV) device has been developed. This is the first evaluation of its use in the management of CSR-CSA in Japanese CHF patients.

METHODS AND RESULTS

Four CHF patients with CSR-CSA that was unresponsive to conventional positive airway pressure (CPAP) underwent 3 nights of polysomnography: baseline, CPAP or bi-level PAP, and on the ASV. The apnea - hypopnea index (AHI) and central-AHI (CAHI) were markedly improved on ASV (AHI 62.7+/-10.1 to 5.9+/-2.2 /h, p=0.0006, CAHI 54.5+/-6.7 to 5.6+/-2.3 /h, p=0.007). In addition, the sleep quality improved significantly on ASV, including arousal index (62.0+/-10.5 to 18.7 +/-6.2 /h, p=0.012), percentage of slow-wave sleep (2.6+/-2.6 to 19.4+/-4.8 %, p=0.042).

CONCLUSIONS

ASV markedly improved CSR-CSA in patients with CHF. It is a promising treatment for Japanese patients with CHF.