Three-Month Treatment with Adaptive Servoventilation Improves Cardiac Function and Physical Activity in Patients with Chronic Heart Failure and Cheyne-Stokes Respiration: A Prospective Randomized Controlled Trial

Abstract

Background: Cheyne-Stokes respiration frequently occurs in patients with congestive heart failure (CHF). Adaptive servoventilation (ASV) is a novel therapy with potential benefits. This prospective randomized trial investigated the effects of ASV on myocardial function and physical capacity. Methods: Patients with severe CHF, despite optimal cardiac medication and/or left ventricular ejection fraction (LVEF) ≤40% and Cheyne-Stokes breathing for >25% of sleeping time were included. Fifty-one patients, age 57-81 years (4 were women), were randomized to either an ASV or a control group; 30 patients completed the study (15 from each group). The primary end point was any change in LVEF. The secondary end points were alterations in physical capacity according to the 6-min walk test or the New York Heart Association (NYHA) class. Results: In the ASV-treatment group, LVEF improved from baseline (32 ± 11%) to study end (36 ± 13%), p = 0.013. The 6-min walk test improved from 377 ± 115 to 430 ± 123 m (p = 0.014) and the NYHA class from 3.2 (3.0-3.0) to 2.0 (2.0-3.0) (p < 0.001). No changes occurred in the control group. Conclusion: Three months of ASV treatment improved LVEF and physical capacity in CHF patients with Cheyne-Stokes respiration. These results suggest that ASV may be a beneficial supplement to standard medication in these patients.

Quality of life improves in patients with chronic heart failure and Cheyne‐Stokes respiration treated with adaptive servo‐ventilation in a nurse‐led heart failure clinic

“…An algorithm registered the patient's minute volume and provided individual adaptive treatment based on a breath‐by‐breath analysis (Hetland et al . ). The AutoSetCS2 register the patient's minute volume in a period of three minutes.…”

“…In our study, patients were regarded as adherent to the protocol if they applied their mask more than four hours every day (Hetland et al . ). If treatment‐time was less than four hours, they were considered as drop‐outs.…”

“…Adaptive servo‐ventilation is reported to induce a greater decrease in the apnoea/hypopnoea‐index than continuous positive airway pressure in CHF patients (Hetland et al . ). Furthermore, adaptive servo‐ventilation also controls central apnoea (Oldenburg et al .…”

“…Treatment with adaptive servo‐ventilation is not as simple as it may seem, as lying with a mask throughout the night may be a challenge (Hetland et al . ). In addition to other factors, most CHF patients with Cheyne‐Stokes respiration in NYHA classes III‐IV or a LVEF ≤ 40% are elderly with impaired QoL (Carmona‐Bernal et al .…”

“…, Hetland et al . ) and improves sleep quality better than continuous positive airway pressure or nasal oxygen (Zhang et al . ).…”