Effects of dynamic bilevel positive airway pressure support on central sleep apnea in men with heart failure

Chest. 2008 Jul;134(1):61-6. doi: 10.1378/chest.07-1620. Epub 2007 Oct 20.

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 H2O above the EPAP.

Results: 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).

Conclusion: Flow-targeted dynamic BPAP support effectively suppresses CSR-CSA in patients with CHF and is well tolerated.

Publication types

  • Clinical Trial

MeSH terms

  • Aged
  • Algorithms
  • Cheyne-Stokes Respiration / etiology*
  • Cheyne-Stokes Respiration / physiopathology
  • Cheyne-Stokes Respiration / therapy*
  • Continuous Positive Airway Pressure / adverse effects
  • Continuous Positive Airway Pressure / instrumentation
  • Continuous Positive Airway Pressure / methods*
  • Heart Failure / complications*
  • Heart Failure / physiopathology
  • Humans
  • Male
  • Middle Aged
  • Polysomnography
  • Pulmonary Ventilation / physiology
  • Sleep Apnea, Central / etiology*
  • Sleep Apnea, Central / physiopathology
  • Sleep Apnea, Central / therapy*
  • Treatment Outcome