The role of high-frequency jet ventilation in the treatment of Cheyne–Stokes respiration in patients with chronic heart failure

Hu, Ke; Li, Q.Q.; Yang, Jiong; Chen, X.Q.; Hu, Suping; Wu, Xiao-Dong

doi:10.1016/j.ijcard.2005.02.005

Cited by 19 publications

(10 citation statements)

References 43 publications

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“…Previous studies have reported inconsistent results in that regard. Some of them showed increased amount of REM and slow-wave sleep, 18,22,23 while according to others, no change in the sleep architecture is present, regardless of the good effect on AHI. 11,20,21 Decreased spectral and time domain parameters of HRV have been described before in CHF patients with CSA and is associated with poor prognosis, including increased risk of sudden cardiac death.…”

Section: Discussionmentioning

confidence: 93%

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The effect of continuous positive airway pressure on heart rate variability during the night in patients with chronic heart failure and central sleep apnoea

Terziyski

Draganova

Taralov

et al. 2016

Clin Exp Pharma Physio

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Continuous positive airway pressure (CPAP) improves autonomic activity in patients with chronic heart failure (CHF) and central sleep apnoea (CSA), but its effect on heart rate variability (HRV) during therapy has not been reported. We hypothesized that CPAP may decrease HRV, despite its beneficial effects on sympathetic overactivation, due to the expected stabilization of breathing. Sixty-seven CHF patients underwent polysomnography (PSG). Ten of them presented with CSA (age 66.1±8.5 years, apnoea-hypopnea index [AHI]=57.6±23.3, central AHI [cAHI]=41.6±24.6 [mean±SD]) and were subjected to a second PSG with manual CPAP titration. Beat-to-beat heart intervals for a 6-hour period of sleep were extracted from each recording and HRV was analysed. CPAP significantly reduced AHI (AHI=23.1±18.3 P=.004). Standard deviation of normal-normal interbeat interval (SDNN) (61.5±29.0 vs 49.5±19.3 ms, P=.021), root mean square of successive differences (RMSSD) (21.8±9.2 vs 16.4±7.1 ms, P=.042), total power (lnTP=7.8±1.1 vs 7.4±0.8 ms , P=.037), low frequency power (lnLF=5.5±1.5 vs 5.0±1.4 ms , P=.003) and high frequency power (lnHF=4.6±1.0 vs 4.0±1.0 ms , P=.024) were decreased. There was a strong correlation between the decrease in AHI and the decrease in lnHF (Spearman's ρ=.782). CPAP leads to a decrease in spectral and time domain parameters of HRV during therapy in CHF patients with CSA. These changes are best explained by the effect which CPAP-influenced breathing pattern and lowered AHI exert on HRV.

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Section: Discussionmentioning

confidence: 93%

“…Previous studies have reported inconsistent results in that regard. Some of them showed increased amount of REM and slow‐wave sleep, while according to others, no change in the sleep architecture is present, regardless of the good effect on AHI …”

Section: Discussionmentioning

confidence: 98%

The effect of continuous positive airway pressure on heart rate variability during the night in patients with chronic heart failure and central sleep apnoea

Terziyski

Draganova

Taralov

et al. 2016

Clin Exp Pharma Physio

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“…[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.…”

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confidence: 99%

Treatment of Central Sleep Apnea in US Veterans

Chowdhuri

Ghabsha

Sinha

et al. 2012

Journal of Clinical Sleep Medicine

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Background: There are no standard therapies for the management of central sleep apnea (CSA). Either positive pressure therapy (PAP) or supplemental oxygen (O 2 ) may stabilize respiration in CSA by reducing ventilatory chemoresponsiveness. Additionally, increasing opioid use and the presence of comorbid conditions in US veterans necessitates investigations into alternative titration protocols to treat CSA. The goal was to report on the effectiveness of titration with PAP, used alone or in conjunction with O 2 , for the management of CSA associated with varying comorbidities and opioid use. Methods: This was a retrospective chart review over 3 years, performed at a VA sleep disorders center. The effects of CPAP, CPAP+O 2 , and BPAP+O 2 , used in a step-wise titration protocol, on consecutive patients diagnosed with CSA were studied. Results: CSA was diagnosed in 162 patients. The protocol was effective in eliminating CSA (CAI ≤ 5/h) in 84% of patients. CPAP was effective in 48%, while CPAP+O 2 combination was effective in an additional 25%, and BPAP+O 2 in 11%. The remaining 16% were non-responders. Forty-seven patients (29%) were on prescribed opioid therapy for chronic pain, in whom CPAP, CPAP+O 2 , or BPAP+O 2 eliminated CSA in 54%, 28%, and 10% cases,, respectively. CPAP, CPAP+O 2 , and BPAP+O 2 each produced signifi cant declines in the AHI, CAI, and arousal index, and an increase in the SpO 2 .Conclusion: The data demonstrate that using a titration protocol with CPAP and then PAP with O 2 effectively eliminates CSA in individuals with underlying comorbid conditions and prescription opioid use. Comparative studies with other therapeutic modalities are required. S C I E N T I F I C I N V E S T I G A T I O N ST he treatment of central sleep apnea (CSA) continues to lack a universally recognized standard of care.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), 2-6 bilevel positive airway pressure therapy (BPAP), 7-9 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. [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. 13,35 The latter entities are of increasing importance in the US veteran population due to the increased use of prescription opioid drugs for chronic pain control and the risk for opioi...

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“…On the one hand, several small studies involving 11 to 16 HF patients with CSA showed a decrease in ArI by 52% to 57% in association with a 40% to 71% reduction in AHI with CPAP therapy. 22,24,25 On the other hand, several studies involving 17 to 26 HF patients with CSA in which CPAP lowered the AHI by 62% to 89% showed no effect on the ArI. 8,[26][27][28] In the largest multicenter trial to date, in which 258 HF patients with CSA were randomized to CPAP treatment or control, CPAP lowered the AHI by 55% after 3 months but did not lower the ArI or improve sleep structure.…”

Section: Discussionmentioning

confidence: 99%

Differential Timing of Arousals in Obstructive and Central Sleep Apnea in Patients with Heart Failure

Simms

Brijbassi

Taranto‐Montemurro

et al. 2013

Journal of Clinical Sleep Medicine

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The role of high-frequency jet ventilation in the treatment of Cheyne–Stokes respiration in patients with chronic heart failure

Cited by 19 publications

References 43 publications

The effect of continuous positive airway pressure on heart rate variability during the night in patients with chronic heart failure and central sleep apnoea

The effect of continuous positive airway pressure on heart rate variability during the night in patients with chronic heart failure and central sleep apnoea

Treatment of Central Sleep Apnea in US Veterans

Differential Timing of Arousals in Obstructive and Central Sleep Apnea in Patients with Heart Failure

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