Adaptive servo-ventilation therapy of central sleep apnoea and its effect on sleep quality.
OBJECTIVES
Poor sleep quality is common in patients with chronic heart failure (CHF). This study tested the hypothesis that adaptive servo-ventilation (ASV) therapy in CHF patients whose central sleep apnoea (CSA) was not suppressed by continuous positive airway pressure (CPAP) (CPAP-non-responders) would improve sleep quality compared to CPAP-responders receiving ongoing CPAP therapy.


METHODS
Eighty-two patients with CHF (65 ± 9 years, left ventricular ejection fraction 35 ± 16 %) and CSA [apnoea-hypopnoea index (AHI) ≥15/h] were retrospectively studied. Within an average of 47 days, patients were reevaluated on CPAP therapy and stratified according to their suppression of CSA: 34 were CPAP-non-responders switched to ASV therapy the following day and 48 were CPAP-responders who continued on CPAP therapy. Polysomnographic parameters were assessed in the diagnostic night and on the last night of PAP therapy (CPAP or ASV) before the patient was discharged with the final pressure settings.


RESULTS
Compared with the CPAP group, the ASV group had significantly greater reductions from baseline in AHI (-37 ± 15/h vs -28 ± 18/h, p = 0.02), arousal index (-12.7 ± 13.6/h vs -6.8 ± 12.5/h, p = 0.04) and sleep stage N1 (-9 ± 14 % vs -2 ± 12 %, p = 0.03). In addition, the ASV group gained significantly more rapid eye movement (REM) sleep compared with the CPAP group (+5 ± 9 % vs +1 ± 9 %, p = 0.02).


CONCLUSIONS
CPAP therapy is effective in reducing AHI in a significant proportion of CHF patients with reduced ejection fraction and CSA. Treatment of CSA with ASV in CHF patients reduces sleep fragmentation and improves sleep structure to a significantly greater extent than changes seen in responders to CPAP therapy.
['Hetzenecker|Andrea|A|', 'Roth|Tatjana|T|', 'Birner|Christoph|C|', 'Maier|Lars S|LS|', 'Pfeifer|Michael|M|', 'Arzt|Michael|M|']
D000368:Aged D002908:Chronic Disease D045422:Continuous Positive Airway Pressure D005260:Female D006333:Heart Failure D006801:Humans D008297:Male D008875:Middle Aged D012119:Respiration D012121:Respiration, Artificial D012189:Retrospective Studies D012307:Risk Factors D012890:Sleep D020182:Sleep Apnea, Central D012893:Sleep Wake Disorders D013318:Stroke Volume D013997:Time Factors D016896:Treatment Outcome D016277:Ventricular Function, Left
Sleep apnoea Sleep quality Heart failure Positive pressure ventilation