Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp by sleep apnea in addition to cardiac unloading by positive pressure. 14 Short-term CPAP (end-expiratory pressure [EEP] 10 cmH2O) in patients with HF modestly increases or does not change muscle sympathetic nerve activity (MSNA), which comprises vasoconstrictor impulses into vascular smooth muscle to regulate systemic blood pressure. 7,15 By contrast, our preliminary study showed that short-term ASV (EEP 5 cmH2O + variable pressure support from 3 to 10 cmH2O) reduced MSNA in patients with HF and periodic breathing (PB). 16 A higher level of CPAP (10 cmH2O) compared with ASV should suppress cardiac performance more in patients with HF who have less congestion, 17 and result in an increase in MSNA. However, it remains unknown whether the effect of ASV on MSNA differs from that of CPAP at comparable pressure levels; whether suppressing PB is important to the sympathoinhibitory effect of these devices in patients with HF also remains unknown.Therefore, the present randomized controlled study examined the hypothesis that ASV would improve respiratory instability more effectively and exert a greater sympathoinhibitory effect than CPAP.reathing abnormalities are very frequently associated with chronic heart failure (HF) and their presence is an indicator of poor prognosis. 1-5 Recent clinical studies have closely related breathing abnormalities to sympathetic overactivation in patients with HF. 6-8 Attenuated sympathetic outflow entrainment mediated by pulmonary mechanoreceptors is considered to be a potent mechanism of sympathetic overactivation in these patients. 9 Editorial p 1323Adaptive servoventilation (ASV) is a novel method of providing positive expiratory airway pressure and of adding varying pressure support (servoventilation function). 10 Ventilation is servo-controlled with a high-gain integral controller to maintain minute ventilation. So far, long-term ASV has conferred the benefit of increased cardiac function determined by ejection fraction (EF) or brain natriuretic peptide (BNP) levels compared with continuous positive airway pressure (CPAP) alone. 11-13 This advantage of ASV might be attributable to more effective alleviation of hypoxia and sympathetic overactivation induced Background: Long-term adaptive servoventilation (ASV) increases cardiac function more effectively than continuous positive airway pressure (CPAP), possibly via alleviation of sympathetic overactivation. The present study evaluated the effect of ASV and CPAP at comparable pressure on muscle sympathetic nerve activity (MSNA) in patients with heart failure (HF) and with or without periodic breathing (PB).

A Japanese family with two siblings of phenotype i is presented. Both had a past history of surgical treatment for congenital cataract. In Japan, 18 individuals of phenotype i, including our case, have been found in ten unrelated families. Seventeen of them had congenital cataract. Cataract was not found in any of the 45 phenotype I members in these families. It is briefly discussed why these two linked and quite rare genes were found in combination only in Japanese persons.

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