Suppressive effects of adaptive servo-ventilation on ventricular premature complexes with attenuation of sympathetic nervous activity in heart failure patients with sleep-disordered breathing

Abstract

Ventricular arrhythmias play a critical role in chronic heart failure (CHF) and are associated with adverse clinical outcomes. Sleep-disordered breathing (SDB) is associated with arrhythmias and/or a poor prognosis in CHF. Adaptive servo-ventilation (ASV) is a ventilatory support system designed to normalize ventilation in CHF patients with SDB. However, the effects of ASV on ventricular arrhythmias and sympathetic nervous activity are still unclear. Nineteen CHF patients with SDB were examined. We performed simultaneous overnight polysomnography and 24-h Holter ECG monitoring, and measured levels of daily urinary catecholamines for two consecutive days (baseline and on ASV). ASV significantly improved the apnea-hypopnea index (p < 0.01), arousal index (p < 0.01), and mean SpO(2) (p < 0.01), and decreased daily urinary catecholamines (0.466-0.353 mg/day, p = 0.016) compared to baseline. Furthermore, power in the low to high frequency range as a marker of sympathetic nervous activity decreased across a 24-h period (24-h period: 2.8-1.9, p = 0.017; during daytime: 3.7-2.3, p = 0.013; and during sleep time: 1.5-1.3, p = 0.026). Importantly, ASV significantly decreased ventricular premature complexes not only during sleep time but also across a 24-h period (40.5-21.9 beats/h, p = 0.013). The short-term use of ASV reduced ventricular arrhythmias with the attenuation of sympathetic nervous activity, as demonstrated by urinary catecholamines and heart rate variability. ASV may have anti-sympathetic nervous and anti-arrhythmic effects for CHF with SDB.

Association between sleep‐disordered breathing and arterial stiffness in heart failure patients with reduced or preserved ejection fraction

“…The Mobil‐O‐Graph 24 h PWA Monitor estimates brachial blood pressure using the oscillometric method,15, 16 and some studies have already reported the reliability of the device by showing good correlation with traditionally used tonometry PWV measurement systems 24, 25…”

“…All subjects underwent overnight full polysomnography (PSG) or were examined by portable recording Type III device with the use of standard techniques and scoring criteria for sleep stages and arousals from sleep as previously reported 23, 24. Briefly, PSG was performed using a computerized system (Alice 5, Philips Respironics, Murrysville, PA, USA) that monitored the patient's electroencephalogram, electrooculogram, submental electromyogram, electrocardiogram, and thoracoabdominal motion.…”

Long-Term Adaptive Servo-Ventilator Treatment Prevents Cardiac Death and Improves Clinical Outcome

“…We here demonstrated the efficacy of ASV therapy at 6 months in patients with advanced HF, mainly represented by NYHA class IV (74%), some of them dependent on inotrope infusion (34%), and all receiving GDMT as far as tolerated (β-blocker, 88%; angiotensin-converting enzyme, 75%; aldosterone antagonist, 62%). At 6 months, the patients' heart rate had decreased significantly, which indicated suppression of sympathetic nerve activity, 14,[25][26][27] owing to the relaxation of the respiratory muscles, and a decrease in pulmonary capillary wedge pressure through a reduction in venous return. 11,12) Consistently with previous reports, [13][14][15][16][17]21,22) facilitation of left ventricular reverse remodeling and an improvement in HF symptoms were also achieved in patients with advanced HF receiving GDMT.…”

Effect of Respiratory Therapy on the Prognosis of Chronic Heart Failure Patients Complicated With Sleep-Disordered Breathing – A Pilot Efficacy Trial –

“…Fourth, the present study did not evaluate the effect of ASV, which has been reported to be effective for CHF and various types of sleep apnea. [42][43][44][45] Conclusions SDB in CHF patients was an independent predictor of fatal arrhythmic events. Conventional RT might improve prognosis if it is able to reduce AHI to <5/h.…”