Beneficial Effects of Adaptive Servo Ventilation in Patients With Chronic Heart Failure

Abstract

Background: Sleep-disordered breathing (SDB) is thought to be a state of inflammation caused by hypoxic stress. Whether adaptive servo ventilation (ASV) attenuates the inflammatory response and improves the cardiac function of patients with congestive heart failure (CHF) accompanied by SDB was not been investigated. Methods and Results:Seventeen inpatients with New York Heart Association (NYHA) II or III underwent polysomnography. There was a positive correlation between the apnea hypopnea index and high-sensitivity C-reactive protein (hs-CRP) level (r=0.753, P=0.016). The patients were divided into ASV (n=10) and non-ASV groups (n=7), and CHF-parameters were measured before and after ASV treatment. Improvement was noted for the NYHA class in the ASV group but not in the non-ASV group. In contrast to the non-ASV group, the level of brain natriuretic peptide (BNP), ejection fraction, and hs-CRP levels in the ASV group significantly improved (BNP, Conclusions: Anti-inflammatory effects of ASV are important contributors for improving cardiac function in patients with CHF accompanied by SDB. (Circ J 2010; 74: 2118 - 2124

Adaptive Servo Ventilation Improves Cardiac Dysfunction and Prognosis in Chronic Heart Failure Patients With Cheyne-Stokes Respiration

“…18,19) Overnight complete polysomnography was performed using a computerized system (Alice5, Philips Respironics, Murrysville, PA, USA) that consisted of monitoring of the electro-encephalogram, electro-oculogram, submental electromyogram, electrocardiogram, thoracoabdominal motion, oronasal airflow by an airflow pressure transducer, and arterial oxyhemoglobin saturation (SpO 2 ) by pulse oximetry. 4,[18][19][20] Apnea was defined as an absence of airflow for more than 10 s. Hypopnea was defined as a > 30% reduction in monitored airflow accompanied by a decrease in SaO 2 of > 4%. 4,[18][19][20] Arousal responses were defined according to the recommendations of the American Sleep Disorders Association.…”

“…4,[18][19][20] Apnea was defined as an absence of airflow for more than 10 s. Hypopnea was defined as a > 30% reduction in monitored airflow accompanied by a decrease in SaO 2 of > 4%. 4,[18][19][20] Arousal responses were defined according to the recommendations of the American Sleep Disorders Association. The apnea-hypopnea index (AHI) was defined as the number of apnea and hypopnea episodes per hour of sleep.…”

A Long-Term Prognosis of Adaptive Servo Ventilation Therapy for Patients with Heart Failure -Consideration in Severity of Sleep-Disordered Breathing-

“…Furthermore, many reports showed that the ASV therapy for the patients with HF was effective. 5,7,9,10,11,[18][19][20][21][22] Although it is well known that the prognosis of patients is negatively correlated with the severity of SDB, 12 little has been reported on the long-term prognosis in patients with HF after initiating ASV therapy. Earlier, we showed that ASV therapy was effective for patients with HF and that it improved their prognosis after one year.…”

“…2,3 Recently, ASV therapy has also been used to treat patients with HF who also have CSA and CSR 2,4,5 as well as patients with SDB, including those with obstructive sleep apnea. 6,7 Cowie et al 8 reported that the ASV therapy for the patients with HF and reduced ejection fraction increased all-cause and cardiovascular mortality. However, previously, we reported that ASV therapy for patients with mild SDB resulted in almost equal improvements in brain natriuretic peptide (BNP) and left ventricular ejection fraction (LVEF) compared with patients with moderate and severe SDB, thus demonstrating that ASV therapy was effective for all patients with HF.…”

Right Ventricular Enlargement and Renal Function Are Associated With Smooth Introduction of Adaptive Servo-Ventilation Therapy in Chronic Heart Failure Patients

“…It has been reported that ASV treatment improves cardiac function in CHF patients. [5][6][7][8][9] Although ASV therapy has beneficial effects on CHF, the intervention is frequently rejected by CHF patients because of unpleasant feelings from the mask or positive airway pressure (PAP). It remains unknown which patient characteristics influence the smooth introduction of ASV therapy.…”