Noninvasive pressure preset ventilation for the treatment of Cheyne-Stokes respiration during sleep

Abstract

Cheyne-Stokes respiration (CSR) during sleep is common in patients with congestive heart failure (CHF). This pattern of breathing fragments sleep, leading to daytime symptoms of sleepiness and fatigue. It was hypothesized that by controlling CSR with noninvasive pressure preset ventilation (NPPV), there would be a decrease in sleep fragmentation and an improvement in sleep quality.Nine patients (eight males, one female; mean±sd 65±11 yrs) with symptomatic CSR diagnosed on overnight polysomnography (apnoea/hypopnoea index (AHI) 49±10·h−1, minimum arterial oxygen saturation (Sa,O2, 77±7%) and CHF (left ventricular ejection fraction 25±8%) were studied. After a period of acclimatization to NPPV (variable positive airway pressure (VPAP) II STTM, Sydney, NSW, Australia and bilevel positive airway pressure (BiPAP)TM, Murraysville, PA, USA), sleep studies were repeated on therapy.NPPV almost completely abolished CSR in all patients with a reduction in AHI from 49±10 to 6±5·h−1(p<0.001). Residual respiratory events were primarily due to upper airway obstruction at sleep on-set. Arousal index was markedly decreased from 42±6 to 17±7·h−1(p<0.001). Sleep architecture showed a trend toward improvement with a reduction in stage 1 and 2 (79±7% during the diagnostic nightversus72±10% during NPPV, (p=0.057)), whilst sleep efficiency, slow-wave sleep (SWS), and rapid eye movement (REM) were not altered.Controlling Cheyne-Stokes respiration with noninvasive pressure preset ventilation resulted in reduced arousal and improved sleep quality in the patients with congestive heart failure. Noninvasive pressure preset ventilation should be considered a potential therapy for Cheyne-Stokes respiration in congestive heart failure in those patients who do not respond or fail to tolerate nasal continuous positive airway pressure therapy.

Efficacy of Nasal Bi-Level Positive Airway Pressure in Congestive Heart Failure Patients With Cheyne - Stokes Respiration and Central Sleep Apnea

“…19 In another study, Willson et al investigated the efficacy of bi-level PAP using 2 different types of bilevel pressure preset device. 23 However, in their study, they only demonstrated an improvement of apnea and sleep status and did not show an improvement of cardiac function. Therefore, this is the first report that has documented a statistically significant improvement in cardiac function with the use of bi-level PAP in CHF patients with CSR-CSA, despite the fact that only a small number of patients were involved.…”

“…22 Several reports have shown the efficacy of bi-level PAP for treating abnormal breathing in patients with CSR-CSA and chronic heart failure. 23,24 However, little is known about the efficacy of bi-level PAP for treating the underlying chronic heart failure. Therefore, we evaluated the efficacy of appropriate bi-level PAP therapy on cardiac function in chronic CHF patients with CSR-CSA.…”

Treatment of Central Sleep Apnea in US Veterans

“…[23][24][25]29,30 The outcomes of therapy have also varied considerably, with limited evidence to establish the effectiveness of any therapy for CSA. [26][27][28][29]31,32 The majority of published literature has focused on the treatment of CSA secondary to congestive heart failure (CHF), [2][3][4][5][6][7][8][9][10][11][15][16][17][18][19][20][21][22][26][27][28][29] with very little data on patients with "primary" CSA 23,24 or CSA secondary to causes other than CHF. 33 In addition, there is very little data on the treatment of CSA related to opioid use and CSA that is concomitant with OSA.…”

“…1 Variable etiologies of CSA and the presence of concomitant disorders infl uence the choice of therapy. Thus, therapeutic options have varied markedly from positive airway pressure (PAP) devices, including continuous positive airway pressure (CPAP), [2][3][4][5][6] bilevel positive airway pressure therapy (BPAP), [7][8][9] and adaptive servoventilation, [10][11][12][13]20 to supplemental O 2 , 14-17 carbon dioxide, 21,22 and/or pharmacologic agents. [23][24][25]29,30 The outcomes of therapy have also varied considerably, with limited evidence to establish the effectiveness of any therapy for CSA.…”

Ventilatory support and pharmacological treatment of patients with central apnoea or hypoventilation during sleep: FIGURE 1.

“…In a case series of nine patients with symptomatic CSR, diagnosed on overnight polysomnography [42], noninvasive pressure preset ventilation almost completely abolished CSR in all patients with a reduction in AHI from 49¡10 to 6¡5 events?h -1 (p,0.001). Arousal index was markedly decreased from 42¡6 to 17¡7 events?h -1 (p ,0.001) and sleep quality showed a trend towards improvement.…”